Chimeric antigen receptor T cells, a savior with a high price

Abstract

Chimeric antigen receptor (CAR) T cells represent a medical and scientific breakthrough that may represent a paradigm for the future of personalized medicine in the age of cancer immunotherapy. As with many new cancer agents, such novel and incredible results come with a high price. At the time of the writing of this article, there are two CAR T cells available, Kymriah, produced by Novrtis with a price tag of US$475,000 and Yescarta produced by Gilead Pharmaceuticals with a price tag of US$373,000, neither price including the required hospital admission in order to administer the agent in addition to potential treatment of side effects. There are several issues that are imperative to recognize when understanding the high cost, however the two more pertinent issues are low availability of the agent and no billing code. While only approved for less than a year, there are thoughts about how to bring the price down with more approved CAR T cells and more center with the ability to administer this therapy, however results may be years away before they are realized. In the short term, insurance companies are grappling over how to pay for CAR T therapy, with one of the biggest voids concerning the absence of a billing code for CAR T cells. Regardless, its high price tag highlights moral issues underlying value-based payments and whether the treatment is worth the cost while evaluating the juxtaposition of life years and monetary values. As CAR T cells expand the boundaries of immunotherapy with extraordinary results, the need for a lower price in combination for more availability of CAR T cells will grow until some of these fundamental issues are addressed.

Immunotherapy and Radioimmunotherapy for Desmoplastic Small Round Cell Tumor

“…These issues have surfaced quickly in the field of CAR T cells, which must be tailor-made for each patient using ex vivo T cell expansion and viral transduction. In the case of Kymriah and Yescarta, the two FDA-approved CAR T cell therapies, the drug cost is currently $475,000 and $373,000 per patient, respectively (93). These prices make them inaccessible for many patients, even those in developed countries.…”

Switching on the green light for chimeric antigen receptor T‐cell therapy

“…91 These high costs are partly attributed to the fact that the process from T-cell collection, genetic modification, to CAR T-cell reinfusion is patient specific. 91 These high costs are partly attributed to the fact that the process from T-cell collection, genetic modification, to CAR T-cell reinfusion is patient specific.…”

“…The two recently approved CD19-CAR T-cell products, Kymriah TM and Yescarta TM , although highly effective, are very expensive treatments, priced at US $475 000 and US $373 000 for a onetime treatment, respectively. 91 These high costs are partly attributed to the fact that the process from T-cell collection, genetic modification, to CAR T-cell reinfusion is patient specific. To make CAR T-cell therapy more broadly applicable to diverse patient populations, strategies to generate universal offthe-shelf CAR T-cell products that can be safely and effectively delivered to multiple recipients will be a key issue to address.…”

Frontiers and Opportunities: Highlights of the 2nd Annual Conference of the Chinese Antibody Society

“…In addition to the above-mentioned antibody programs, Yu also introduced the flourishing INDs of engineered T-cell therapy in China. The US FDA has approved one dendritic cell therapy (Sipuleucel-T, Provenge) and two CAR-T products [ 7 , 8 ]. China has 15 CAR-T filed for IND as of 29 April 2018.…”