Cost-Effectiveness Strategies Vital for Streamlining Care in Hematologic Malignancies

One of the prominent gaps in hematologic research, argues Sabarish Ayyappan, MD, City of Hope Cancer Center, Atlanta, is the lack of cost-effectiveness studies. Efforts to unveil cost-related outcomes and compile more data in this area can ultimately alleviate health system burden and elevate care for patients with hematologic malignancies, such as multiple myeloma and lymphoma, who receive chimeric antigen receptor (CAR) T-cell or bispecific antibody therapies.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What future innovations or policy changes do you believe could further streamline the implementation of bispecifics and CAR T-cell therapies

I think at this point it'll be good to do more cost-effectiveness studies to see if a patient is being treated in the outpatient rather than being admitted for the step-up dosing or inpatient hospital stays—although sometimes the drugs are now offered for free by some of the companies. Hospital stays, the patients occupying beds to be monitored for cytokine release syndrome, and the fact that the patient is in the hospital also is not something that's appealing to the patients. Those kinds of things could be looked at.

As we are learning more [about] how we could safely administer both CAR T-cell therapy and bispecific antibody therapies with adequate infrastructure support, you need a hospital with an emergency room [and] trained people at night who could [tend] to these patients if they have any sort of toxicity, like cytokine release syndrome or ICANS [immune effector cell-associated neurotoxicity syndrome]. Also, using some of these novel technologies, like remote monitoring devices where they could monitor their vitals, blood pressure, and other things, which can actually pass on the information very quickly to the treating physician or the team, so that they can act on these patients very well.

I could envision these patients mostly getting these therapies as outpatient, and that way you reduce the burden of them being admitted for either monitoring, for that cytokine release syndrome or for ICANS, and other things as inpatient, reducing the burden on the inpatient service that way. It kind of saves the hospital bed that could be used for other patients. And I think cost effectiveness and looking at all that would help the negotiation between the hospitals and payers to do this more frequently.