Exploring Financing Models for CAR-T Cell Therapies in Global Healthcare Systems: A Comprehensive Scoping Review

OBJECTIVES: This scoping review aims to explore and analyze various financing models for Chimeric Antigen Receptor T-cell (CAR-T) therapy in healthcare systems globally. It seeks to understand the diverse funding strategies and identify potential alternatives that could facilitate broader access to this innovative therapy.

METHODS: A comprehensive scoping review was conducted, utilizing MEDLINE (via PubMed) and LILACS databases (search date: March 6, 2023). The search strategy encompassed terms relevant to the therapy (specifically, Adoptive Immunotherapy) and its financing context, without language restrictions, focusing on literature published since 2018. Additionally, a manual search of literature was performed, which included references from the selected studies and grey literature. The protocol for this review is registered and accessible (doi: 10.17605/OSF.IO/95ACK).

RESULTS: From a total of 615 references initially evaluated, 29 publications were deemed relevant and included in the review. The analysis identified 15 countries with healthcare systems, encompassing both public and private sectors, that currently finance CAR-T cell therapies. The most frequently implemented financing models were outcome-based payment (OBP) schemes (n=8), sometimes combined with coverage with evidence development (CED) (n=8). This was followed by the diagnosis-related group (DRG) model, occasionally supplemented with additional payments (add-on payments) (n=3). Notably, some OBPs were established directly with the manufacturers as part of a broader risk-sharing policy.

CONCLUSIONS: The clinical uncertainties regarding CAR-T cell therapy and its high cost still prevent many healthcare systems from funding it. Risk-sharing agreements may be an alternative to mitigate the impact of uncertainties in their effectiveness, however, they are not the only possible strategies to be used. OBPs associated with CED seem a promising way to increase access and foster the development of evidence on their effectiveness. It is important for managers to anticipate by seeking alternative financing for these therapies.