Characteristics of Medicare Beneficiaries With Multiple Administrations of CAR-T Therapy

OBJECTIVES: Chimeric antigen receptor T-cell therapy (CAR-T), approved in Q4 2017, initially saw limited uptake due to its single indication and the high-cost. Since then, both the number of indications and CAR-T products have increased. The seven-year increase in CAR-T utilization now provides sufficient data to evaluate patients who have received multiple treatments.

METHODS: This study analyzed the 100% Medicare Fee-For-Service Research Identifiable Files (RIFs) from Q4 2017 through Q2 2023 and the Medicare Advantage Encounter dataset from 2017 through 2021. Patients were selected if they received two administrations of CAR-T on different days. Both inpatient and outpatient settings were assessed.

RESULTS: Our data contained 6,150 unique Medicare beneficiaries that received CAR-T since 2017. Of these, 160 (2.6%) beneficiaries received two CAR-T infusions. A small number (<11) received more than two CAR-T but were excluded from the analysis. The beneficiaries with CAR-T reoccurrence had an average age of 68.6, 64% male, and 83% white. Those with a single occurrence of CAR-T had similar demographics (69.6 years, 60% male, 82% white). However, the six-month mortality of beneficiaries with two CAR-T (41%) was significantly higher than those receiving a single CAR-T (21%). The majority (91%) of beneficiaries with two CAR-T received both treatments in the inpatient setting. The average time between CAR-T therapies was 289 days (median=205; SD=288). Changes between the two CAR-T administrations with regards to the beneficiaries’ clinical characteristics, diagnoses, and provider administration were explored.

CONCLUSIONS: In the coming years, more patients will be receiving reoccurring CAR-T therapy. This initial group will be important for the evaluation of health outcomes and effectiveness of the therapy.