Treatment patterns and out-of-pocket cost after CAR-T cell therapy in commercially insured patients with hematologic malignancies: A real-world US study.

Abstract

11045 Background: Chimeric Antigen Receptor T (CAR-T) cell therapy has improved outcomes in hematologic malignancies since its FDA approval in 2017. However, real-world data on treatment patterns and out-of-pocket (OOP) costs after CAR-T failure or cancer relapse remain limited. This study evaluated subsequent treatment risk, patterns, and OOP costs post-CAR-T therapy. Methods: A retrospective cohort study was conducted using the Merative MarketScan database (2017–2022). Commercially insured patients receiving CAR-T for acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), or primary mediastinal large B-cell lymphoma (PMBCL) were included. Patients had ≥6 months of continuous insurance enrollment before the index date (CAR-T administration date) and were followed until disenrollment or the end of 2022. Initiation of additional therapy >14 days post-index (chemotherapy, immunotherapy, stem cell transplant, or radiotherapy) served as a proxy for CAR-T failure or relapse, with cumulative risk estimated using Kaplan-Meier methods. OOP costs (outpatient, inpatient, and prescription claims) were calculated for patients with ≥6 months of post-index enrollment and adjusted to 2022 USD. Results: Of the 246 patients, 22 had ALL, 185 DLBCL, 15 FL, 23 MCL, and 1 PMBCL. The mean age was 53.2 years (SD: 10.7), and 69.9% of patients were male. Overall, 98 patients (39.8%) initiated subsequent therapy. The cumulative risk of CAR-T failure was 21.3% (95% CI: 16.8%-25.8%) at 3 months, 37.0% (95% CI: 30.1%-43.9%) at 6 months, and 51.5% (95% CI: 43.5%-59.4%) at 12 months. After CAR-T failure, the most common first-line therapies were lenalidomide (n=12), ibrutinib (n=7), and pembrolizumab (n=5) for DLBCL, and blinatumomab (n=3) and ruxolitinib (n=2) for ALL. Total OOP costs incurred over six months were $310,246.2, with outpatient services accounting for 66.0%. The mean per-patient OOP cost for six months was $2,248.2. While the median OOP costs were similar between groups, mean per-patient OOP costs were higher for patients who required subsequent therapy ($2,881.0 vs $1,910.7), with some patients facing costs as high as $38,889.2. Conclusions: This study highlights a substantial risk of CAR-T failure, with targeted therapies and immunotherapies commonly used post-CAR-T. OOP costs were significant, particularly for patients requiring additional therapy, with considerable variability. These findings emphasize the need for strategies to improve outcomes and reduce financial toxicity in this population.