The Cost of Treating AEs Due to CAR T-Cell Therapy Treatment

Chimeric antigen receptor (CAR) T-cell therapies, like tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (aix-cel), have greatly improved outcomes for patients with diseases like diffuse large B-cell lymphoma (DLBCL). However, these therapies are not without adverse events (AEs) and extra costs related to health care resource utilization (HRU). Two recent posters presented at AMCP Nexus 2021 reviewed the costs of these AEs.

The first poster summarized information from 4 real-world evidence studies of tisa-cel and axi-cel to quantify the associated the costs.1 AE management and costs analyzed included outpatient (OP), inpatient (IP), and intensive care unit (ICU) visits, as well as pharmacy services.

Across the 4 studies (published in 2019 and 2020), between 1% and 4% of patients receiving tisa-cel and between 7% and 16% of patients receiving axi-cel experienced grade ≥ 3 cytokine release syndrome (CRS). Between 0% and 5% of patients receiving tisa-cel and between 20% and 35% of patients receiving axi-cel experienced grade ≥3 neurotoxicity events.

Up to 20% of patients on tisa-cel and as much as 71% of patients on axi-cel used tocilizumab, which is used to treat CRS. As other research has shown, axi-cel was far more likely to be infused in the IP setting (92%-100%) compared with tisa-cel (36%), in addition the median hospitalization days was higher for axi-cel (15-16 days vs 2 days). In the 28 days after infusion, the median number of OP visits for tisa-cel was 6 vs 4 for axi-cel.

While the median days in the ICU was similar among the 2 therapies (4 days for tisa-cel and 5 days for axi-cel), only 7% of tisa-cel patients were transferred to the ICU compared with 28% to 38% of patients on axi-cel.

Overall, the costs associated with axi-cel were significantly higher than for tisa-cel:

• $5979 to $10,878 for total estimated costs for managing patients for axi-cel vs $843 to $1962 for tisa-cel
• $32394 to $33166 for the total estimated HRU costs per patient for axi-cel vs $3321 for tisa-cel

“The additional cost burden for axi-cel was primarily driven by the incremental ICU and hospitalization due to a higher proportion of IP infusion among [patients] receiving axi-cel,” the authors concluded.

A second poster estimated the total patient cost of CRS and neurological events (NEs) for patients with large B-cell lymphoma (LBCL) treated with axi-cel, tisa-cel, or lisocabtagene maraleucel (liso-cel).2

The authors developed a model that incorporated AEs of CRS and NE using data from the TRANSCEND NHL 001, ZUMA-1, and JULIET clinical trials. They found:

1. The overall weighted average cost per patient was $18,718 for liso-cel, $47,665 for axi-cel, and $42,538 for tisa-cel
2. Per patient weighted average cost of CRS was $8,213 for liso-cel, $20,442 for axi-cel, and $26,009 for tisa-cel
3. Per patient weighted average cost per NE was $10,505 for liso-cel, $27,223 for axi-cel, and $16,528 for tisa-cel

The lower cost of potential CRS and NE management for liso-cel was due to the lower rates, according to the authors.

“These findings highlight the economic implications of differences in safety among CAR T cell therapies,” the authors concluded.

References

1. Lim S, Bollu V, Dalal A, et al. Estimating costs of adverse events (AEs) and healthcare resource use (HRU) in patients (pts) with relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) receiving tisagenlecleucel and axicabtagene ciloleucel in real-world setting. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, Colorado. Abstract C38.

2. Badaracco J, Keating S, Gitlin M. Updates to an economic model to estimate costs of cytokine release syndrome (CRS) and neurological events (NE) with chimeric antigen receptor (CAR) T cell therapies in patients (Pts) with relapsed or refractory (R/R) large b-cell lymphoma (LBCL). Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, Colorado. Abstract D13.