Price and Prejudice? The Value of Chimeric Antigen Receptor (CAR) T-Cell Therapy

Abstract

Although chimeric antigen receptor (CAR) T-cell therapy has shown a high response rate in lymphoma patients, its cost-effectiveness is controversial due to the high price and uncertainty of the clinical evidence. In addition to the high acquisition cost of CAR T-cell therapy, procedure and facility cost increase the financial burden considering the frequency of adverse events such as cytokine release syndrome. In clinical research, relatively short follow-up periods were used compared to traditional cancer agents. In addition, head-to-head comparative effectiveness data are unavailable, which is an important factor when evaluating the cost-effectiveness of a new treatment. Additional evidence that will compensate for the uncertainty of existing clinical data is needed for full evaluation of long-term efficacy, safety, and comparative effectiveness

Nanocarrier-based gene delivery for immune cell engineering

“…(The total cost of treatment for CAR T-cell therapy is estimated at about $500 000 for the patient. 206 ) Clinical development and translation of these methods can change the process of cancer immunotherapy from ex vivo to in vivo and provide an off-the-shelf product that does not require using the patient's own immune cells for immunotherapy. Due to the possibility of in vivo methods, using nanocarriers, and transferring mRNA (that has a transient expression), we can always have some engineered cells of the immune system in a certain therapeutic window.…”

Toward the clinical development of synthetic immunity to cancer

“…Furthermore, cell therapy development is expensive and can hamper iteration at the clinical stage. 84 Real change in patient outcomes will not only continue to drive scientific discovery but promote continued investment for clinical stage programs.…”

“…Engineering for dominant rather than marginal improvement is particularly important for the patient populations who will first receive these therapies, as cell therapies are typically the last resort for a refractory tumor. Furthermore, cell therapy development is expensive and can hamper iteration at the clinical stage 84 . Real change in patient outcomes will not only continue to drive scientific discovery but promote continued investment for clinical stage programs.…”

Expanding CAR-T cell immunotherapy horizons through microfluidics

“…9 Moreover, the high cost of CAR-T cell therapy is a major barrier to its widespread accessibility and benefit. 10 Safety concerns related to mutagenesis and off-targeting effects due to the use of viruses, limited scalability, lack of standardization because of manufacturing challenges, along with other obstacles, hinder the democratization of the therapy. 11 Thus, immediately addressing these limitations to boost the adoption of CAR-T cell therapy is crucial.…”