Real-World Experience and Optimization of Outpatient Chimeric Antigen Receptor T Cell Therapy

McGann, Mary; Davis, James A.; Gaffney, Kelly J; Smith, Deidra; Edwards, Kathy; Hess, Brian; Hashmi, Hamza

doi:10.1016/j.jtct.2022.06.021

Cited by 11 publications

(13 citation statements)

References 9 publications

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“…Cilta-cel provides flexibility for outpatient administration due to delayed onset of CRS events. Outpatient CAR-T administration with frequent monitoring and early intervention can provide a mechanism to decrease healthcare costs by reducing the length of inpatient hospitalization following CAR-T therapy [ 20 ]. These analyses demonstrate that outpatient administration of cilta-cel CAR-T therapy could lead to decreased per patient peri-infusion costs ($4232 for outpatient administration versus $23,154 inpatient administration per patient; Table 1 ), and lower overall costs of CAR-T therapy, as well as reduced HCRU associated with hospitalization during the peri-infusion phase.…”

Section: Discussionmentioning

confidence: 99%

Component Costs of CAR-T Therapy in Addition to Treatment Acquisition Costs in Patients with Multiple Myeloma

et al. 2023

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Introduction: Ciltacabtagene autoleucel (ciltacel), is a B-cell maturation antigen-directed, genetically modified autologous chimeric antigen receptor T-cell (CAR-T) immunotherapy. It is indicated for treatment for adult patients with relapsed or refractory multiple myeloma (RRMM) after four or more prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. The objective of this study was to estimate the per-patient US commercial healthcare costs related to cilta-cel (CARVYKTI Ò ) CAR-T therapy (i.e., costs separate from cilta-cel therapy acquisition) for patients with RRMM. Methods: US prescribing information for ciltacel, publicly available data, and published literature were used with clinician input to identify the cost components and unit costs associated with administration of cilta-cel. Cost components included apheresis, bridging therapy, conditioning therapy, administration, and postinfusion monitoring for 1 year of follow-up. Adverse event (AE) management costs for all grades of cytokine release syndrome and neurologic toxicities, and additional AEs grade C 3 occurring in [ 5% of patients were included in the analysis. Results: The estimated per-patient average costs of cilta-cel CAR-T therapy administered exclusively in an inpatient setting, excluding cilta-cel therapy acquisition costs, totaled US$160,933 over a 12 month period. Costs assuming different proportions of inpatient/ outpatient administration (85%/15% and 70%/ 30%) were US$158,095 and US$155,257, respectively. Conclusion: Cost estimates from this analysis, which disaggregates CAR-T therapy costs, provide a comprehensive view of the cost components of CAR-T therapy that can help healthcare decision-makers make informed choices regarding the use of cilta-cel. Real-world

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Section: Discussionmentioning

confidence: 99%

Component Costs of CAR-T Therapy in Addition to Treatment Acquisition Costs in Patients with Multiple Myeloma

et al. 2023

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“…The feasibility of this approach has been demonstrated by other centres that have also successfully established outpatient CAR T‐cell therapy programmes without compromising safety or clinical outcomes. Several reports confirm similar overall and progression‐free survival among outpatients who received CD19‐directed CAR T‐cell therapy with tisagenlecleucel without increased cytokine release syndrome (CRS) or immune effector cell‐associated neurotoxicity syndrome (ICANS) when compared with inpatient therapy 2–4 . However, it should be noted that patient selection plays a role in these results, since each centre could have specific guidelines to determine patient eligibility for outpatient management related to pre‐existing comorbidities, the particular CAR product administered, disease burden and reliability of follow‐up.…”

mentioning

confidence: 84%

“…For example, a comprehensive clinical infrastructure is needed to ensure that patients are seen in clinic multiple times per week for follow‐up and transfusion support; this may be necessary for at least 1 month or longer in some cases. Close follow‐up and check‐ins with the patients are also required to initiate supportive care in the event of CRS or evidence of ICANS 2,3 . As Ly et al report, 83% of their patients were admitted to the hospital following CD19 CAR T‐cell infusion.…”

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confidence: 99%

Moving CAR‐Ts to the outpatient clinic

Llaurador,

Heslop,

Steffin

2023

Br J Haematol

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As centres obtain more experience with commercial CARs, there has been increasing interest in trying to move as much as the procedure as possible to the outpatient clinic to reduce costs, maximize reimbursement and increase patient satisfaction. The report by Ly et al. details how their centre implemented outpatient CAR therapy and were able to reduce admission time without affecting outcomes.Commentary on: Ly et al. Outpatient CD19‐directed CAR T‐cell therapy is feasible in patients of all ages. Br J Haematol 2023 (Online ahead of print). doi: 10.1111/bjh.19090.

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“…The frequency of clinical follow up visits (both in-person and telehealth) may not be feasible in all institutions due to staffing demands, resources, and patient or caretaker limitations. The Medical University of South Carolina group reported their real-world experience with outpatient CAR-T. Of the 32 patients who received outpatient infusion, hospitalization was not required through day +30 for 4 (12.5%) patients ( 18 ).…”

Section: Cd19 Targeted Car T-cell Therapy For B-cell Malignanciesmentioning

confidence: 99%

Outpatient administration of CAR T-cell therapy: a focused review with recommendations for implementation in community based centers

Perez,

Al Sagheer,

Nahas

et al. 2024

Front. Immunol.

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Chimeric Antigen Receptor T-cell (CAR-T) therapy has transformed the treatment landscape for hematological malignancies, showing high efficacy in patients with relapsed or refractory (R/R) disease and otherwise poor prognosis in the pre-CAR-T era. These therapies have been usually administered in the inpatient setting due to the risk of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). However, there is a growing interest in the transition to outpatient administration due to multiple reasons. We review available evidence regarding safety and feasibility of outpatient administration of CD19 targeted and BCMA targeted CAR T-cell therapy with an emphasis on the implementation of outpatient CAR-T programs in community-based centers.

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Real-World Experience and Optimization of Outpatient Chimeric Antigen Receptor T Cell Therapy

Cited by 11 publications

References 9 publications

Component Costs of CAR-T Therapy in Addition to Treatment Acquisition Costs in Patients with Multiple Myeloma

Component Costs of CAR-T Therapy in Addition to Treatment Acquisition Costs in Patients with Multiple Myeloma

Moving CAR‐Ts to the outpatient clinic

Outpatient administration of CAR T-cell therapy: a focused review with recommendations for implementation in community based centers

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