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Original article

Vol. 153 No. 9 (2023)

Real-world expenditures and survival time after CAR-T treatment for large B-cell lymphoma in Switzerland: a retrospective study using insurance claims data

  • Maria Trottmann
  • Eva Blozik
  • Marcel Hilbig
  • Daniel LoVerdi
  • Marcello Pedruzzi
  • Tina Scherer
  • Martina Weiss
  • Mark Pletscher
  • Niklaus Meier
DOI
https://doi.org/10.57187/s.3441
Cite this as:
Swiss Med Wkly. 2023;153:s3441
Published
29.09.2023

Summary

AIM OF THE STUDY: Newly approved therapies with high and uncertain budget impact pose challenges to public health care systems worldwide. One recent example is chimeric antigen receptor T cell (CAR-T) therapies for adults with large B-cell lymphoma (LBCL). This study’s primary objective is to examine the expenditures of Swiss public payers before, during, and after CAR-T cell therapy in patients with LBCL aged ≥30 years. Its secondary objective is to analyse 24-month survival rates.

METHODS: This retrospective observational data analysis used the administrative databases of the Swiss health insurers Concordia, CSS, Groupe Mutuel, Helsana, ÖKK, Sanitas, SWICA, Sympany, and Visana. These health insurers or groups provide mandatory health insurance to approximately 78% of Swiss residents in 2021. Using the relevant procedure codes, we identified CAR-T therapies administered between October 2018 (first approval) and June 2021 (treatment identification cut-off). Patients aged <30 years were excluded because they might be treated for pediatric acute lymphoblastic leukaemia. Expenditures were categorised as pre-infusion, peri-infusion (excluding CAR-T therapy acquisition costs), and post-infusion based on the time of service provision. Overall survival rates were estimated using the Kaplan–Meier method.

RESULTS: This study identified 81 patients aged ≥30 years, with a median follow-up period for censored observations of 27 months (interquartile range: 21–31 months). The median age group was 70–74, and 60% of patients were male. Mean healthcare expenditures per patient per month amounted to CHF 8,115–22,564 pre-infusion, CHF 38,490 peri-infusion, and CHF 5,068–11,342 post-infusion. For the total peri- and post-infusion period (i.e. 1-month before infusion to 23 months after infusion), mean healthcare expenditures amounted to CHF 215,737. The 24-month overall survival rate was 48% (95% confidence interval: 38–61%).

CONCLUSIONS: Healthcare expenditures after CAR-T cell infusion are relatively high compared to previous estimates of patients with LBCL in the last year of treatment. Further research is needed to understand the drivers behind these post-infusion expenditures. Especially, clinical data should be used to assess the time until disease progression. The analysis of 24-month overall survival is consistent with results from the pivotal trials. Our findings stress the importance of post-approval studies to monitor real-world expenditures and outcomes related to innovative therapies.

References

  1. Schuster SJ, Bishop MR, Tam CS, Waller EK, Borchmann P, McGuirk JP, et al.; JULIET Investigators. Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-Cell Lymphoma. N Engl J Med. 2019 Jan;380(1):45–56. 10.1056/NEJMoa1804980 DOI: https://doi.org/10.1056/NEJMoa1804980
  2. Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, et al. Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma. N Engl J Med. 2017 Dec;377(26):2531–44. 10.1056/NEJMoa1707447 DOI: https://doi.org/10.1056/NEJMoa1707447
  3. Crump M, Neelapu SS, Farooq U, Van Den Neste E, Kuruvilla J, Westin J, et al. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood. 2017 Oct;130(16):1800–8. 10.1182/blood-2017-03-769620 DOI: https://doi.org/10.1182/blood-2017-03-769620
  4. Chacim S, Monjardino T, Cunha JL, Medeiros P, Redondo P, Bento MJ, et al. Costs, effectiveness, and safety associated with Chimeric Antigen Receptor (CAR) T-cell therapy: results from a comprehensive cancer center. PLoS One. 2022 Dec;17(12):e0278950. 10.1371/journal.pone.0278950 DOI: https://doi.org/10.1371/journal.pone.0278950
  5. Sahli B, Eckwright D, Darling E, Gleason PP, Leach JW. Chimeric antigen receptor T-cell therapy real-world assessment of total cost of care and clinical events for the treatment of relapsed or refractory lymphoma. J Clin Oncol. 2021 May;39(15 _suppl):e19500–19500. 10.1200/JCO.2021.39.15_suppl.e19500 DOI: https://doi.org/10.1200/JCO.2021.39.15_suppl.e19500
  6. Keating SJ, Gu T, Jun MP, McBride A. Health Care Resource Utilization and Total Costs of Care Among Patients with Diffuse Large B Cell Lymphoma Treated with Chimeric Antigen Receptor T Cell Therapy in the United States. Transplant Cell Ther. 2022 Jul;28(7):404.e1–6. 10.1016/j.jtct.2022.03.021 DOI: https://doi.org/10.1016/j.jtct.2022.03.021
  7. M. Di et al., “Total Costs of Care during Chimeric Antigen Receptor T-Cell Therapy in Patients with Relapsed/Refractory B Cell Non-Hodgkin Lymphoma: A Large Private Insurance Claim-Based Analysis,” Blood, vol. 140, no. Supplement 1, pp. 10818–10819, Nov. 2022, doi: 10.1182/blood-2022-164915. DOI: https://doi.org/10.1182/blood-2022-164915
  8. D. Chihara et al., “Real-World Effectiveness and Economic Impact Associated with Chimeric Antigen Receptor T-Cell Therapy Among Older Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma in US,” Blood, vol. 140, no. Supplement 1, pp. 2421–2423, Nov. 2022, doi: 10.1182/blood-2022-163678. DOI: https://doi.org/10.1182/blood-2022-163678
  9. Swiss Federal Office of Public Health (2022) Statistik der obligatorischen Krankenversicherung 2021. Tabelle T 5.05, access on 15.08.2022.
  10. Stolz S, Roncador M, Rösler W, Zenz T, Manz MG, Müller AM, et al. Introducing innovative cellular therapies into the clinic: a 2-year retrospective experience of a chimeric antigen receptor T-cell programme at a single centre in Switzerland. Swiss Med Wkly. 2022 Jun;152(25–26):w30186. 10.4414/smw.2022.w30186 10.4414/SMW.2022.w30186 DOI: https://doi.org/10.4414/SMW.2022.w30186
  11. Schuster SJ, Tam CS, Borchmann P, Worel N, McGuirk JP, Holte H, et al. Long-term clinical outcomes of tisagenlecleucel in patients with relapsed or refractory aggressive B-cell lymphomas (JULIET): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol. 2021 Oct;22(10):1403–15. 10.1016/S1470-2045(21)00375-2 DOI: https://doi.org/10.1016/S1470-2045(21)00375-2
  12. Locke FL, Ghobadi A, Jacobson CA, Miklos DB, Lekakis LJ, Oluwole OO, et al. Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, phase 1-2 trial. Lancet Oncol. 2019 Jan;20(1):31–42. 10.1016/S1470-2045(18)30864-7
  13. Krankenpflege-Leistungsverordnung KLV, Anhang 1.
  14. Morrison VA, Shou Y, Bell JA, Hamilton L, Ogbonnaya A, Raju A, et al. Evaluation of treatment patterns and survival among patients with diffuse large B-cell lymphoma in the USA. Future Oncol. 2019 Mar;15(9):1021–34. 10.2217/fon-2018-0788 DOI: https://doi.org/10.2217/fon-2018-0788
  15. Wieser S, et al. Die Kosten der nichtübertragbaren Krankheiten in der Schweiz. Winterthur: Zurich University of Applied Sciences, Winterthur Institute of Health Economics; 2014.
  16. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011 Jan;103(2):117–28. 10.1093/jnci/djq495 DOI: https://doi.org/10.1093/jnci/djq495
  17. Moradi-Lakeh M, Yaghoubi M, Seitz P, Javanbakht M, Brock E. Cost-Effectiveness of Tisagenlecleucel in Paediatric Acute Lymphoblastic Leukaemia (pALL) and Adult Diffuse Large B-Cell Lymphoma (DLBCL) in Switzerland. Adv Ther. 2021 Jun;38(6):3427–43. 10.1007/s12325-021-01767-x DOI: https://doi.org/10.1007/s12325-021-01767-x
  18. Jalbert JJ, Wu N, Chen CI, Ambati S, Ge W, Arnason JE. Real-World Treatment Patterns After CD19-Directed CAR T Cell Therapy Among Patients with Diffuse Large B Cell Lymphoma. Adv Ther. 2022 Jun;39(6):2630–40. 10.1007/s12325-022-02087-4 DOI: https://doi.org/10.1007/s12325-022-02087-4
  19. Bachy E, Le Gouill S, Di Blasi R, Sesques P, Manson G, Cartron G, et al. A real-world comparison of tisagenlecleucel and axicabtagene ciloleucel CAR T cells in relapsed or refractory diffuse large B cell lymphoma. Nat Med. 2022 Oct;28(10):2145–54. 10.1038/s41591-022-01969-y DOI: https://doi.org/10.1038/s41591-022-01969-y
  20. W. A. Bethge et al., “GLA/DRST real-world outcome analysis of CAR-T cell therapies for large B-cell lymphoma in Germany,” Blood, p. blood.2021015209, Mar. 2022, doi: 10.1182/blood.2021015209. DOI: https://doi.org/10.1182/blood.2021015209
  21. Shadman M, Pasquini M, Ahn KW, Chen Y, Turtle CJ, Hematti P, et al. Autologous transplant vs chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission. Blood. 2022 Mar;139(9):1330–9. 10.1182/blood.2021013289 DOI: https://doi.org/10.1182/blood.2021013289
  22. Swiss Federal Statistical Office (2022): Life expectancy.
  23. Maziarz RT, Zhang J, Yang H, Chai X, Yuan C, Schwarz E, et al. Indirect comparison of tisagenlecleucel and historical treatments for relapsed/refractory diffuse large B-cell lymphoma. Blood Adv. 2022 Apr;6(8):2536–47. 10.1182/bloodadvances.2021006280 DOI: https://doi.org/10.1182/bloodadvances.2021006280
  24. Salles G, Spin P, Liu FF, Garcia J, Kim Y, Hasskarl J. Indirect Treatment Comparison of Liso-Cel vs. Salvage Chemotherapy in Diffuse Large B-Cell Lymphoma: TRANSCEND vs. SCHOLAR-1. Adv Ther. 2021 Jun;38(6):3266–80. 10.1007/s12325-021-01756-0 DOI: https://doi.org/10.1007/s12325-021-01756-0
  25. Sermer D, Batlevi C, Palomba ML, Shah G, Lin RJ, Perales MA, et al. Outcomes in patients with DLBCL treated with commercial CAR T cells compared with alternate therapies. Blood Adv. 2020 Oct;4(19):4669–78. 10.1182/bloodadvances.2020002118 DOI: https://doi.org/10.1182/bloodadvances.2020002118
  26. Vokinger KN, Kesselheim AS, Glaus CE, Hwang TJ. Therapeutic Value of Drugs Granted Accelerated Approval or Conditional Marketing Authorization in the US and Europe From 2007 to 2021. JAMA Health Forum. 2022 Aug;3(8):e222685. 10.1001/jamahealthforum.2022.2685 DOI: https://doi.org/10.1001/jamahealthforum.2022.2685

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