Fred Hutchinson Cancer Research Center, Seattle, Washington.
Department of Health Sciences, School of Public Health, University of Washington, Seattle.
JAMA Netw Open. 2020 Apr 1;3(4):e202072. doi: 10.1001/jamanetworkopen.2020.2072.
Chimeric antigen receptor (CAR) T-cell therapies are currently administered at a limited number of cancer centers and are primarily delivered in an inpatient setting. However, variations in total costs associated with these therapies remain unknown.
To estimate the economic differences in the administration of CAR T-cell therapy by the site of care and the incidence of key adverse events.
DESIGN, SETTING, AND PARTICIPANTS: A decision-tree model was designed to capture clinical outcomes and associated costs during a predefined period (from lymphodepletion to 30 days after the receipt of CAR T-cell infusion) to account for the potential incidence of acute adverse events and to evaluate variations in total costs for the administration of CAR T-cell therapy by site of care. Cost estimates were from the health care practitioner perspective and were based on data obtained from the literature and publicly available databases, including the Healthcare Cost and Utilization Project National Inpatient Sample, the Medicare Hospital Outpatient Prospective Payment System, the Medicare physician fee schedule, the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System, and the IBM Micromedex RED BOOK. The model evaluated an average adult patient with relapsed or refractory large B-cell lymphoma who received CAR T-cell therapy in an academic inpatient hospital or nonacademic specialty oncology network.
The administration of CAR T-cell therapy.
Total cost of the administration of CAR T-cell therapy by site of care. The costs associated with lymphodepletion, acquisition and infusion of CAR T cells, and management of acute adverse events were also examined.
The estimated total cost of care associated with the administration of CAR T-cell therapy was $454 611 (95% CI, $452 466-$458 267) in the academic hospital inpatient setting compared with $421 624 (95% CI, $417 204-$422 325) in the nonacademic specialty oncology network setting, for a difference of $32 987. After excluding the CAR T-cell acquisition cost, hospitalization and office visit costs were $53 360 (65.3% of the total cost) in academic inpatient hospitals and $23 526 (48.4% of the total cost) in nonacademic specialty oncology networks. The administration of CAR T-cell therapy in nonacademic specialty oncology networks was associated with a $29 834 (55.9%) decrease in hospitalization and office visit costs and a $3154 (20.1%) decrease in procedure costs.
The potential availability of CAR T-cell therapies that are associated with a lower incidence of adverse events and are suitable for outpatient administration may reduce the total costs of care by enabling the use of these therapies in nonacademic specialty oncology networks.
嵌合抗原受体 (CAR) T 细胞疗法目前在少数癌症中心进行，并主要在住院环境下提供。然而，这些疗法相关总成本的差异尚不清楚。
评估通过护理场所和关键不良事件发生率来评估 CAR T 细胞疗法管理方面的经济差异。
设计、地点和参与者：设计了决策树模型，以在预定义时间段内（从淋巴细胞耗竭到接受 CAR T 细胞输注后 30 天）捕获临床结果和相关成本，以考虑潜在的急性不良事件发生率，并评估通过护理场所进行 CAR T 细胞疗法管理方面的总成本差异。成本估算来自医疗保健从业者的角度，并基于从文献和公开数据库中获得的数据，包括医疗保健成本和利用项目国家住院样本、医疗保险医院门诊预付制、医疗保险医师费用表、医疗保险和医疗补助服务医疗共同程序编码系统以及 IBM Micromedex RED BOOK。该模型评估了一名接受 CAR T 细胞治疗的复发性或难治性大 B 细胞淋巴瘤成年患者，该患者在学术住院医院或非学术专业肿瘤网络中接受治疗。
CAR T 细胞疗法的管理。
按护理场所划分的 CAR T 细胞疗法管理总成本。还检查了与淋巴细胞耗竭、CAR T 细胞的获取和输注以及急性不良事件管理相关的成本。
在学术医院住院环境下，与非学术专业肿瘤网络环境下的 421624 美元（95%CI，417204 美元至 422325 美元）相比，CAR T 细胞疗法管理相关的估计总成本为 454611 美元（95%CI，452466 美元至 458267 美元），差异为 32987 美元。在排除 CAR T 细胞获取成本后，学术住院医院的住院和就诊费用为 53360 美元（占总成本的 65.3%），而非学术专业肿瘤网络的住院和就诊费用为 23526 美元（占总成本的 48.4%）。非学术专业肿瘤网络中 CAR T 细胞疗法的管理与住院和就诊费用减少 29834 美元（55.9%）和手术费用减少 3154 美元（20.1%）相关。
潜在的可用 CAR T 细胞疗法具有较低的不良事件发生率且适合门诊管理，这可能会通过允许在非学术专业肿瘤网络中使用这些疗法来降低总护理成本。
