Barriers to CAR-T Therapy Access in the U.S.: A County-Level Analysis of Proximity and Sociodemographic Factors
Author(s)
sebastian l. mendoza1, Michael Romanko, PhD2;
1Redondo Beach, CA, USA, 2terumo bct, denver, CO, USA
1Redondo Beach, CA, USA, 2terumo bct, denver, CO, USA
OBJECTIVES: With 6 FDA approved Chimeric Antigen Receptor T cell (CAR-T) therapies available in the United States (U.S.) the potential to deliver transformative life-saving care to cancer patients has never been greater. But despite efficacy and approvals there are still several barriers to treatment including the proximity patients reside with respect to treatment centers and sociodemographic characteristics.
METHODS: Our study attempts to measure these barriers by estimating population sizes, their respective income level and their distance from the nearest treatment center across the U.S. on a county level. One hundred forty-one hospitals were identified as treatment centers across the U.S. by the Blood & Marrow Transplant Information Network (BMT InfoNet) as locations performing one or more approved CAR-T therapies. It is necessary for patients to reside within 120 min of the treatment center for several weeks after treatment so they can be appropriately monitored for adverse effects.
RESULTS: Assuming the average one-way commute time as reported by the U.S. Census Bureau in 2019 to be approximately 30 miles per hour, our results showed 94,206,087 people (29.02 % of the population) would need to travel > 120 minutes, approximately 60 miles, to the nearest treatment center. When accounting for sociodemographic characteristics, 37,687,805people (11.61 %) in a low-income bracket, median household income of < 56,600 $, would need to travel > 120 minutes. This population could be considered at risk of relocation and economic distress
CONCLUSIONS: Though this analysis does not account for incidence rates and eligibility to specific CAR-T therapies these results still provide evidence of the disparity of access to treatment in the U.S. especially for those with lower incomes. Additionally, this demonstrates that the proximity to treatment centers and sociodemographic characteristics are definitive barriers to access. This analysis helps identify specific regions within the U.S. for industry stakeholders when establishing new treatment centers.
METHODS: Our study attempts to measure these barriers by estimating population sizes, their respective income level and their distance from the nearest treatment center across the U.S. on a county level. One hundred forty-one hospitals were identified as treatment centers across the U.S. by the Blood & Marrow Transplant Information Network (BMT InfoNet) as locations performing one or more approved CAR-T therapies. It is necessary for patients to reside within 120 min of the treatment center for several weeks after treatment so they can be appropriately monitored for adverse effects.
RESULTS: Assuming the average one-way commute time as reported by the U.S. Census Bureau in 2019 to be approximately 30 miles per hour, our results showed 94,206,087 people (29.02 % of the population) would need to travel > 120 minutes, approximately 60 miles, to the nearest treatment center. When accounting for sociodemographic characteristics, 37,687,805people (11.61 %) in a low-income bracket, median household income of < 56,600 $, would need to travel > 120 minutes. This population could be considered at risk of relocation and economic distress
CONCLUSIONS: Though this analysis does not account for incidence rates and eligibility to specific CAR-T therapies these results still provide evidence of the disparity of access to treatment in the U.S. especially for those with lower incomes. Additionally, this demonstrates that the proximity to treatment centers and sociodemographic characteristics are definitive barriers to access. This analysis helps identify specific regions within the U.S. for industry stakeholders when establishing new treatment centers.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
MSR27
Topic
Methodological & Statistical Research
Disease
SDC: Oncology, SDC: Rare & Orphan Diseases, STA: Genetic, Regenerative & Curative Therapies