CAR-TUTILIZATION BEFORE AND AFTER THE APPROVAL AS A SECOND-LINE THERAPY FOR DIFFUSE LARGE B-CELL LYMPHOMA PATIENTS: AN INTERRUPTED TIME SERIES ANALYSIS
Author(s)
Yinan Wang, PhD, MPP, Jieni Li, PhD, MPH, Rajender R. Aparasu, PhD, FAPhA.
University of Houston, Houston, TX, USA.
University of Houston, Houston, TX, USA.
OBJECTIVES: The Food and Drug Administration (FDA) approved axicabtagene ciloleucel, a chimeric antigen receptor T-cell (CAR-T) therapy, for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) as a second-line therapy in April 2022. Before this approval, CAR-T therapy was restricted to third-line or later stages. This study investigated the impact of second-line approval on the utilization of CAR-T therapy in DLBCL.
METHODS: We used 2019-2024 Merative MarketScan Commercial and Medicare claims data to identify the utilization rates of CAR-T therapy and chemoimmunotherapy among DLBCL patients with continuous enrollment. We conducted single-group interrupted time series (ITS) analyses involving two medication use patterns. The first outcome was utilization of CAR-T, measured by quarterly utilization per 100,000 DLBCL patients. We used an autoregressive model with a lag of 2 to assess the impact on CAR-T use. The second outcome was the utilization of first-line chemoimmunotherapy, measured by quarterly utilization per 100,000 DLBCL patients. We used an ordinary least squares model to examine the impact of chemoimmunotherapy utilization because no autocorrelation was detected.
RESULTS: The study identified 12,122 patients with DLBC, 6.17% received CAR-T therapy, and 21.59% received first-line therapy. We found that observations were significantly correlated with those two quarters earlier (p=0.02). The ITS model with a lag of 2 revealed an immediate level increase in quarterly CAR-T use after the policy change (mean estimate 63.22, p<0.01). The post-intervention trend did not differ significantly from the pre-intervention trend (1.03, p=0.59). The regression model found no significant change in level (12.99, p=0.66) or trend (-2.16, p=0.62) in the use of chemoimmunotherapy.
CONCLUSIONS: Approval of CAR-T therapy as second-line therapy significantly increased the immediate level of CAR-T use but did not change the underlying trend of CAR-T use or the level or trend of first-line chemoimmunotherapy use.
METHODS: We used 2019-2024 Merative MarketScan Commercial and Medicare claims data to identify the utilization rates of CAR-T therapy and chemoimmunotherapy among DLBCL patients with continuous enrollment. We conducted single-group interrupted time series (ITS) analyses involving two medication use patterns. The first outcome was utilization of CAR-T, measured by quarterly utilization per 100,000 DLBCL patients. We used an autoregressive model with a lag of 2 to assess the impact on CAR-T use. The second outcome was the utilization of first-line chemoimmunotherapy, measured by quarterly utilization per 100,000 DLBCL patients. We used an ordinary least squares model to examine the impact of chemoimmunotherapy utilization because no autocorrelation was detected.
RESULTS: The study identified 12,122 patients with DLBC, 6.17% received CAR-T therapy, and 21.59% received first-line therapy. We found that observations were significantly correlated with those two quarters earlier (p=0.02). The ITS model with a lag of 2 revealed an immediate level increase in quarterly CAR-T use after the policy change (mean estimate 63.22, p<0.01). The post-intervention trend did not differ significantly from the pre-intervention trend (1.03, p=0.59). The regression model found no significant change in level (12.99, p=0.66) or trend (-2.16, p=0.62) in the use of chemoimmunotherapy.
CONCLUSIONS: Approval of CAR-T therapy as second-line therapy significantly increased the immediate level of CAR-T use but did not change the underlying trend of CAR-T use or the level or trend of first-line chemoimmunotherapy use.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR115
Topic
Health Policy & Regulatory
Topic Subcategory
Approval & Labeling
Disease
SDC: Oncology