Real-world CAR-T treatment costs can range from $700,000 to $1 million

CAR-T treatment costs go beyond the product.  Prime shows total cost impact.

When Kymriah^® and Yescarta^®. launched in 2017 and 2018, respectively, the market focus was primarily on the price of administering those therapies. (At the time of this study, both had approvals to treat relapsed or refractory B-cell lymphomas and were priced at $373,000.)

But no one really knew much about the total treatment cost. 

The process takes several weeks. The patient needs conditioning chemotherapy before receiving the cell therapy and may need to be hospitalized after infusion due to treatment side effects. This is the first study to take a look at that. 

From its 15 million commercially insured member population, Prime found 74 patients that had this treatment between January 18 and June 2020. The study evaluated these 74 individuals over two time periods: 

• The CAR-T episode (86 days: 30 days before CAR-T administration to 56 days after)
• Outcome event follow-up period (begins 56 days after CAR-T administration; goes for minimum 26 days, 288 mean, 990 maximum number of days)

Prime evaluated costs beginning 30 days prior to CAR-T administration through 56 days after CAR-T administration. And Prime tallied non-financial outcome events from 56 days after CAR-T administration until the end of the analytic period (or as long as enrollment allowed).

No one had gathered baseline data on those costs, or the following outcomes.  Key findings:

• Total cost of care was high: The average cost of care for patients receiving CAR-T therapy was more than $700,000. For 12% of the patients, total cost of care exceeded $1 million.
• 39% did not have a durable CAR-T response: 30% of patients that received CAR-T therapy went on to receive further chemotherapy. One in 20 received a bone marrow transplant. 

An analysis like this requires the integrated medical and pharmacy claims data and health outcomes research expertise that Prime provides. 

A 2018 Institute for Clinical and Economic Review (ICER) report on the two CAR-T therapies suggested the therapies are priced in alignment with their clinical value despite their high price.  But ICER’s study capped hospital mark-up at $100,000 per treatment. Prime’s real-world evidence is another barometer to consider when evaluating whether CAR-T’s pricing is in line with the value it provides to members.

The FDA has said they will be approving 10 to 20 cell and gene therapy products a year by 2025. 

Studies like this can help with forecasting and with value-based negotiations with manufacturers. Improved outcomes data and reporting processes will be needed to support a new level of value-based contract. Improved data reporting could also help inform emerging treatment guidelines and decisions.