Geographic Trends in Chimeric Antigen Receptor (CAR) T-Cell Therapy Access and Utilization

OBJECTIVES: Healthcare facilities must invest in specialized infrastructure and meet specific criteria to provide chimeric antigen receptor (CAR) T-cell therapy. CAR T was originally limited to centers of excellence, producing geographic clusters in access. This study aimed to evaluate trends in the geographic distribution of CAR T sites, setting of care, and utilization from 2018 to 2022.

METHODS: A descriptive analysis of Medicare FFS CAR T providers, 2018 – 2022. Inpatient and outpatient claims were linked to Medicare Cost Reports to obtain hospital characteristics and location. Utilization by site and facility type (teaching, PPS-exempt), location (state), and setting of care (inpatient vs outpatient) were described across the five-year period.

RESULTS: From 2018-2022, the number of CAR T administration sites increased by 195%, from 42 sites to 125. The number of states with CAR T providers grew from 27 to 41 states. Despite an increase in both inpatient and outpatient CAR T claims (201 to 1,296), the proportion of administrations in the outpatient setting remained flat at 9%.

CAR T procedures were primarily administered by teaching hospitals located in urban areas (98%). In 2018, the top 4 sites represented 48% of all CAR Ts, and 20% in 2022. PPS-exempt sites performed 43% of all CAR Ts in 2018 and 22% in 2022. Utilization remained concentrated geographically. Nine sites across 3 states (California, Florida, and Texas) administered nearly one-third of inpatient CAR Ts in 2018 and 2022 (32% and 26%, respectively). Three sites across 3 states (Pennsylvania, Minnesota, and Tennessee) performed 40% of all outpatient CAR Ts.

CONCLUSIONS: Despite expansion of CAR T sites between 2018 and 2022, utilization remains geographically concentrated, especially for outpatient use. The geography of sites and type of providers administering CAR T may contribute to disparities in access. Expanding CAR T sites is critical to mitigating patient financial and travel-related barriers.