Real-world Infusion and Post-Infusion Health Care Resource Use (HCRU) and Costs for CAR T Cell Treatment in Large B-Cell Lymphoma (LBCL): a Comparative Study of Liso-cel Versus Axi-cel
Author(s)
Simran K. Tiwana, MBA, PhD1, Masoom Priyadarshini, MS, MPharm1, Jacob Klimek, PhD2, Enrico Zanardo, PhD3, Lynn Huynh, BA, MPH, MBA, DrPH2, Mihran Yenikomshian, BA, MBA2.
1Bristol Myers Squibb, Princeton, NJ, USA, 2Analysis Group, Boston, MA, USA, 3Analysis Group, Denver, CO, USA.
1Bristol Myers Squibb, Princeton, NJ, USA, 2Analysis Group, Boston, MA, USA, 3Analysis Group, Denver, CO, USA.
Presentation Documents
OBJECTIVES: This retrospective study compares infusion and post-infusion inpatient, critical care (CC), and outpatient visits and associated costs for patients with LBCL treated with liso-cel versus axi-cel.
METHODS: HCRU data were obtained from Symphony Integrated Dataverse, a national claims database. Estimated 2024 US dollar costs were obtained multiplying HCRU by unit costs sourced from public databases and literature. Estimated unit costs from a published CAR T cell study were used for sensitivity analysis (Maziarz et al. Leuk Lymphoma 2022). HCRU was evaluated at infusion and for 90 days after infusion. Cumulative costs (infusion plus 90 days post-infusion) were also estimated. Comparisons used regression models adjusted for key baseline characteristics.
RESULTS: A total of 1066 eligible patients were identified (03/01/2017‒10/31/2023); 236 received liso-cel (40% outpatient infusions; mean age, 69.6 years; Quan-Charlson Comorbidity Index [CCI], 4.3) and 830 received axi-cel (14% outpatient infusions; mean age, 60.7 years; Quan-CCI, 4.1). Average length of stay for inpatient infusion was 5.6 days (liso-cel) and 8.2 days (axi-cel). Among patients with ≥1 CC day during infusion (liso-cel, 7 [4.9%]; axi-cel, 50 [7.0%]), CC days were 1.9 (liso-cel) and 3.6 (axi-cel). Average infusion costs were $16,606 (liso-cel) and $35,519 (axi-cel). During the 90 days of follow-up after end of infusion, inpatient days per patient per month were 0.8 (liso-cel) and 1.3 (axi-cel). Outpatient visits were 4.3 (liso-cel) and 3.8 (axi-cel). Post-infusion inpatient days were significantly lower for liso-cel (adjusted rate ratio, 0.51; P<0.001). Average cumulative costs (infusion plus 90-day follow-up) were $29,915 (liso-cel) and $55,059 (axi-cel) and were significantly lower for liso-cel (adjusted mean difference [aMD], −$21,944; P<0.001). In a sensitivity analysis, cumulative costs were $42,135 (liso-cel) and $77,322 (axi-cel); liso-cel remained significantly less costly (aMD, −$30,583; P<0.001).
CONCLUSIONS: Liso-cel infusion and 90-day follow-up costs were significantly lower than axi-cel. Results were robust to alternative cost inputs.
METHODS: HCRU data were obtained from Symphony Integrated Dataverse, a national claims database. Estimated 2024 US dollar costs were obtained multiplying HCRU by unit costs sourced from public databases and literature. Estimated unit costs from a published CAR T cell study were used for sensitivity analysis (Maziarz et al. Leuk Lymphoma 2022). HCRU was evaluated at infusion and for 90 days after infusion. Cumulative costs (infusion plus 90 days post-infusion) were also estimated. Comparisons used regression models adjusted for key baseline characteristics.
RESULTS: A total of 1066 eligible patients were identified (03/01/2017‒10/31/2023); 236 received liso-cel (40% outpatient infusions; mean age, 69.6 years; Quan-Charlson Comorbidity Index [CCI], 4.3) and 830 received axi-cel (14% outpatient infusions; mean age, 60.7 years; Quan-CCI, 4.1). Average length of stay for inpatient infusion was 5.6 days (liso-cel) and 8.2 days (axi-cel). Among patients with ≥1 CC day during infusion (liso-cel, 7 [4.9%]; axi-cel, 50 [7.0%]), CC days were 1.9 (liso-cel) and 3.6 (axi-cel). Average infusion costs were $16,606 (liso-cel) and $35,519 (axi-cel). During the 90 days of follow-up after end of infusion, inpatient days per patient per month were 0.8 (liso-cel) and 1.3 (axi-cel). Outpatient visits were 4.3 (liso-cel) and 3.8 (axi-cel). Post-infusion inpatient days were significantly lower for liso-cel (adjusted rate ratio, 0.51; P<0.001). Average cumulative costs (infusion plus 90-day follow-up) were $29,915 (liso-cel) and $55,059 (axi-cel) and were significantly lower for liso-cel (adjusted mean difference [aMD], −$21,944; P<0.001). In a sensitivity analysis, cumulative costs were $42,135 (liso-cel) and $77,322 (axi-cel); liso-cel remained significantly less costly (aMD, −$30,583; P<0.001).
CONCLUSIONS: Liso-cel infusion and 90-day follow-up costs were significantly lower than axi-cel. Results were robust to alternative cost inputs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE200
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology, STA: Biologics & Biosimilars