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2272 Real-World Comparison of Healthcare Costs and Resource Utilization Among Patients with Relapsed-Refractory Large B-Cell Lymphoma Treated with CAR T-Cell Therapy Versus Historical Standard-of-Care: A Cost-Consequence Analysis in Ontario, Canada

Program: Oral and Poster Abstracts
Session: 902. Health Services and Quality Improvement: Lymphoid Malignancies: Poster I
Hematology Disease Topics & Pathways:
Research, Adult, Clinical Practice (Health Services and Quality), Lymphomas, Non-Hodgkin lymphoma, Clinical Research, Health outcomes research, B Cell lymphoma, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Diseases, Real-world evidence, Aggressive lymphoma, Treatment Considerations, Biological therapies, Adverse Events, Lymphoid Malignancies, Non-Biological therapies, Study Population, Human
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Tiana Kordbacheh, MBBS, PhD, BSc1, Anca Prica, MD, MSc1,2*, Kelvin KW Chan, MD, PhD3*, Mahmood Aminilari, PhD4*, Zharmaine Ante5*, Ning Liu, PhD6*, Inna Y Gong, MD, PhD1,2, Sita D. Bhella, MD1,7, Michael Crump, MD1,2*, Abi Vijenthira, MD, SM2,8, John Kuruvilla, MD, FRCPC2,9, Robert Kridel, PhD1,2, Christine I Chen, MHPE, MD2,10, Vishal Kukreti, MD, MSc2,8, Chloe Yang, MD2,11*, Nauman Malik4,12*, David Hodgson, MD4,12* and Danielle Rodin, MD, MPH4,12*

1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
2Department of Medicine, University of Toronto, Toronto, ON, Canada
3Division of Hematology and Oncology, Department of Medicine, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
4Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
5Research & Analysis, ICES, Toronto, ON, Canada
6ICES, Toronto, ON, Canada
7University of Toronto, Toronto, ON, Canada
8Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
9Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
10Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
11Princess Margaret Cancer Centre, Toronto, ON, Canada
12Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada

Background

Chimeric Antigen Receptor T-cell therapy (CAR-T) has transformed the management of relapsed-refractory large B-cell lymphoma (RR LBCL) by offering the potential for long-term survival to patients who have exhausted other curative intent treatment. In 2019, the Canadian Agency for Drugs and Technologies in Health recommended funding CAR-T for patients with RR LBCL progressing after two or more lines of systemic therapy. However, CAR-T is resource-intensive to deliver and is associated with significant toxicity and health resource utilization. Real world data on healthcare spending associated with CAR-T is required to assist decision-makers and ensure its efficient and equitable delivery. We compared healthcare costs among a cohort of patients receiving CAR-T with a cohort of historical patients treated prior to CAR-T approval at Princess Margaret (PM) Cancer Centre in Toronto, Canada.

Methods

Using linked, institutional and population-based clinical and administrative databases in Ontario, Canada, patients with RR LBCL consecutively treated at PM with CAR-T (2020-2022) were compared to a historical PM control cohort of RR LBCL patients treated prior to CAR-T approval (2012-2017). Patients were followed from the date of progression following 2 lines of chemotherapy (2L) in the historical controls and date of progression after last therapy (2L or higher) prior to receiving CAR-T for up to 3-years, with maximum follow-up to March 31, 2023. Stabilized inverse probability of treatment weighting (sIPTW) was used to balance baseline covariates between the cohorts (age, sex, lactate dehydrogenase, and comorbidities). sIPTW-weighted Kaplan-Meier curves and Cox proportional hazard regression were used to estimate OS probability and hazard ratios (HR) for CAR-T patients versus historical controls. Generalized linear regression modelling was used to estimate total and resource-specific healthcare costs (2024 Canadian dollars), including mean 3-year incremental costs between the two arms (excluding CAR-T drug cost to focus on healthcare resource expenses [Axi-cel $485,021; Tisa-cel $450,000]). Costs were adjusted for censoring using inverse probability of censoring weighting (IPCW).

Results

Cohorts of 86 CAR-T-treated patients and 150 historical control patients were evaluated. After applying sIPTW, baseline variables were balanced between the two groups: mean age was 56 years and males comprised 61%. The 3-year OS probability was 57% (95% CI 39-71%) in the CAR-T group and 10% (95% CI 5-16%) in the historical control group, with an IPTW-adjusted HR of 0.22 (95% CI 0.15-0.33) for all-cause death. IPCW-adjusted 3-year mean [standard deviation (SD)] total healthcare cost per CAR-T patient was $141,870 [$125,251] vs $55,388 [$40,833] in historical controls (p<0.001), resulting in a mean 3-year incremental total healthcare cost of $86,482 (95% CI $64,422-108,542) in the CAR-T cohort. The majority of healthcare spending in both cohorts was incurred through inpatient days (42% of CAR-T total expenditure vs 44% in historical controls). CAR-T patients incurred a mean 3-year incremental inpatient cost of $34,720 [95% CI $22,625-46,816], which represented 40% of the incremental total healthcare cost for CAR-T patients. The CAR-T cohort also had significantly higher mean 3-year incremental healthcare resource costs than historical control patients in: ambulatory cancer clinics ($14,663 [95% CI $9,609-19,717]; 17% of incremental total healthcare cost), outpatient clinic visits ($11,782 [95% CI $9,122-14,442]; 14%), physician costs ($8718 [95% CI $5,913-11,523]; 10%), oral drug costs ($7,676 [95% CI $2,605-12,747]; 9%), and systemic chemotherapy drug costs ($4,729 [95% CI $1,435-8,022]; 5%).

Conclusion

In this real-world analysis, CAR-T therapy was associated with improved survival as well as higher healthcare costs compared to patients treated with historical standard-of-care therapies. Greater inpatient care needs amongst the CAR-T cohort were a significant contributor to the higher overall spending observed, followed by clinic, physician, and additional drug costs. These data provide important considerations for funders and decision-makers in determining the value of CAR-T therapy in Ontario. These cost parameters can also inform future economic modelling of CAR-T therapy.

Disclosures: Bhella: Kite/Gilead: Consultancy, Honoraria. Crump: Roche: Research Funding; Kyte/Gilead: Honoraria; Epizyme/Ipsen: Research Funding; Canada's Drug Agency (CADTH): Honoraria. Kuruvilla: F. Hoffmann-La Roche Ltd, AstraZeneca, Merck, Novartis: Research Funding; DSMB Karyopharm: Other; AbbVie, Amgen, AstraZeneca, BMS, Genmab, Gilead, Incyte, Janssen, Merck, Novartis, Pfizer, F. Hoffmann-La Roche Ltd, Seattle Genetics: Honoraria; AbbVie, BMS, Gilead, Merck, F. Hoffmann-La Roche Ltd, Seattle Genetics: Consultancy. Chen: Eli Lilly and Company: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astrazeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beigene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Forus Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees. Rodin: Need Inc: Consultancy, Current holder of stock options in a privately-held company.

*signifies non-member of ASH