Methods to Include the Organizational Impacts in Health-Economic Evaluations: Experience From CAR-T in France

OBJECTIVES: This study aims to describe the methods used to evaluate the organizational impact of CAR-T cell therapies in the health economic analyses in France and to identify key areas of improvement for future health-economic evaluations.

METHODS: Descriptive review of economic opinions from the HAS (French HTA body) medico-economic commission (CEESP), published from January 2019 to December 2023 on CAR-T cell therapy, by identifying the elements leveraged to measure the organizational impacts that affect the three HAS macro-criteria that document organizational impact.

RESULTS: Six economic opinions published by HAS on CAR-T cell therapies were analyzed.

Considering the health insurance perspective of CEESP health-economic evaluations; organizational impacts were measured and valorized only by additional costs. Changes in administration modalities and patient’s follow up impacted costs categories and introduced new expenses: additional treatments before CAR-T administration, longer distance from patients’ home to qualified healthcare centers, specific adverse events, necessity to stay hosted near the hospital before administration and after administration for surveillance, healthcare professional training and storage cost. CAR-T cell therapy administration and follow-up costs ranges from 20 494,76€ to 27 092,77€ per patient, versus around 3 000€ for standard treatments. All these costs are included in the three macro-criteria defined by the HAS: change in the process, changes in training requirements and impact on inequalities and accessibility for patients.

A patient perspective could also be an additional mean to measure, in a comprehensive way, all the CAR-T organizational impacts by considering these impacts on patient’s quality of life (impact of long-life treatments) in the patients’ quality of life.

CONCLUSIONS: All the CAR-T evaluations measured the organizational impacts in terms of costs. In addition to the HAS methodological guide concerning the definition of organizational impacts, evaluate costs and quality of live associated with CAR-T cell therapy would harmonize and improve the evaluation of its organizational impacts.