CAR-T Therapy Total Cost Estimates Revealed

04/30/18

A research letter published in JAMA Oncology (online April 26 2018; doi:10.1001/jamaoncol.2018.0977) sheds light on the average additional costs associated with chimeric antigen receptor T (CAR-T) therapy, which can be from $30,000 to $36,000 per patient.

Treatment with the US Food and Drug Administration approved CAR-T therapies tisagenlecleucel and axicabtagene ciloleucel have been priced at $475,000 and $373,000, respectively. However, these prices do not account for the costs associated with leukapheresis, lymphodepletion therapy, and adverse events of CAR-T therapy.

Inmaculada Hernandez, PharmD, PhD, assistant professor of pharmacy and therapeutics, University of Pittsburgh, and colleagues conducted a study to estimate the total costs of CAR-T therapy, including non-drug costs, by utilizing publicly available data. Eleven scenarios that accounted for variability in receipt of treatment, development of cytokine release syndrome (CRS), and response to therapy were identified.

The mean expected cost per patient treated was calculated by adding the expected costs of the drug product in each scenario and its expected probability, divided by the probability of being treated.

Results of the analysis showed that the total costs of treatment with tisagenlecleucel per patient ranged from $478,777 for those without CRS to $531,823 for those with grade 3 or higher CRS, a difference in more than $53,000 per patient. The mean expected cost is $510,963, which decreased to $432,131 under an outcomes-based pricing arrangement, Dr Hernandez and colleagues wrote.

Furthermore, the mean expected cost of axicabtagene ciloleucel per patient treated is $402,647, researchers found.

Accounting for the expected 600 US patients eligible for tisagenlecleucel annually, the annual expenditures would be approximately $250 million. Likewise, the total expenditures for the 7500 US patients eligible for axicabtagene ciloleucel would exceed $3 billion.

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Dr Hernandez and colleagues noted that the costs of the non-drug costs reported in their study are equivalent to the costs of many of today’s most expensive medication. “Payers and the public must understand that only the costs born by the manufacturer, but not the total costs of CAR-T immunotherapy, will be reimbursed for those who display no treatment response,” they wrote.

“Accurately measuring and accounting for the associated non-drug costs will be important when assessing the treatment’s true costs and value and when negotiating pricing arrangements,” they added.—Zachary Bessette