Presentation (CTI)

OBJECTIVES: Previous studies have shown there are disparities in access to chimeric antigen receptor T-cell therapy (CAR-T) treatments. There is little known about real-world access to CAR-T outside of clinical trials. This study describes real-world patterns for CAR-T treatment.
METHODS: We analyzed a retrospective cohort of patients diagnosed with hematological cancer from 2022 through 2024 using 100% Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) claims data. Descriptive statistics and mean distance from the patient zip code to CAR-T treatment center zip code was assessed. Inverse probability of treatment weighting (IPTW) was used to balance cohorts. Statistical comparisons were made using t-tests for continuous variables and Chi-square tests for categorical variables.
RESULTS: Of the patients diagnosed with hematological cancer, 1,802 (0.2%) received CAR-T outside of clinical trials. Fewer MA patients received CAR-T (40.0%) compared to FFS (60.0%). MA plans have a larger proportion of Black (12.0 % vs 4.2%, p <.001) and Hispanic (4.9% vs 1.8%, p <.001) patients receiving CAR-T. The distribution of race/ethnicity between patients diagnosed with cancer was similar to the distribution of those receiving CAR-T for MA patients. However, in FFS the proportion of Black patients receiving CAR-T (4.2%) is lower than the proportion diagnosed with cancer (6.8%). No disparities observed in age or sex. FFS patients had a longer distance to travel to treatment compared to MA patients (125 miles vs 95 miles, p=0.022). Post-IPTW, the average distance to treatment centers for Black patients was 57 miles compared to 116 miles for White patients (p= 0.023).
CONCLUSIONS: This study shows that racial disparities persist in real-world access to CAR-T. Black patients, despite living closer to treatment centers, receive CAR-T at a lower rate if they have FSS compared to MA. Strategies to ensure equitable access to this innovative therapy should aim to address underlying disparities.