Cost Trends for Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Management in Relapsed/Refractory Large B-cell Lymphoma (R/R LBCL) Treatment With Axicabtagene Ciloleucel (Axi-cel) in the US
Author(s)
Frederick L Locke, MD1, Jaymin Patel, PharmD2, Sam Hong, MS, PharmD3, Ruslan Horblyuk, MBA, PhD2, Babatunde Adedokun, PhD3, Genevieve Meier, MSc, PharmD2, Markqayne Ray, MBA, PharmD3, Julia Snider, PhD3, Marcelo Pasquini, MD4.
1H. Lee Moffitt Cancer Center, Tampa, FL, USA, 2AESARA, Chapel Hill, NC, USA, 3Kite, Santa Monica, CA, USA, 4Center for International Blood and Marrow Transplant Registry (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
1H. Lee Moffitt Cancer Center, Tampa, FL, USA, 2AESARA, Chapel Hill, NC, USA, 3Kite, Santa Monica, CA, USA, 4Center for International Blood and Marrow Transplant Registry (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
OBJECTIVES: Chimeric antigen receptor (CAR)-T-cell therapy, including axi-cel, has demonstrated improved outcomes vs high-dose chemotherapy and autologous stem-cell transplant in R/R LBCL. However, adverse events (AE) like CRS and ICANS may still impact patient experience and healthcare costs. Real-world evidence suggests that the overall incidence of CRS and ICANS is decreasing; however, the economic impact of these improvements remain unknown. This study evaluates cost trends associated with the management of CRS and ICANS among patients with R/R 3L+ LBCL who received axi-cel between 2017-2023 in the US.
METHODS: An economic evaluation of the AE rates from the CIBMTR registry (Wang et al, ASH 2024) of patients with R/R LBCL receiving axi-cel between 2017-2023 was performed. Incidence of CRS and ICANS was reported over three time periods (2017-2019, 2020-2021, and 2022-2023) and costs were from published literature. Due to limited CRS and ICANS costing publications in patients with LBCL treated with CAR-T, AE management estimates (ie, facility, procedures, medications, diagnostics) encompassed other hematologic malignancies including multiple myeloma, follicular lymphoma, and others. Costs were inflated to 2025 USD. Additional sensitivities were performed.
RESULTS: The total weighted median costs associated with CRS management declined 20% from $20,835 (2017-2019) to $16,704 (2022-2023) per patient. Similarly, total weighted median ICANS management costs decreased by 34% ($10,503 to $6,977). The management costs associated with severe (Grade >3) CRS and ICANS were reduced by 74% and 32%, respectively.
CONCLUSIONS: This assessment demonstrated a reduction in AE management costs over time due to a lower incidence of severe AEs. Improvements in AE management may reflect increased institutional experience with CAR-T therapies and greater proficiency in managing AEs. The lower incidence of severe AEs and associated costs underscores the reduced impact on healthcare systems, and costs may potentially decline further if the observed trends toward improved AE management and reduced AE rates continue.
METHODS: An economic evaluation of the AE rates from the CIBMTR registry (Wang et al, ASH 2024) of patients with R/R LBCL receiving axi-cel between 2017-2023 was performed. Incidence of CRS and ICANS was reported over three time periods (2017-2019, 2020-2021, and 2022-2023) and costs were from published literature. Due to limited CRS and ICANS costing publications in patients with LBCL treated with CAR-T, AE management estimates (ie, facility, procedures, medications, diagnostics) encompassed other hematologic malignancies including multiple myeloma, follicular lymphoma, and others. Costs were inflated to 2025 USD. Additional sensitivities were performed.
RESULTS: The total weighted median costs associated with CRS management declined 20% from $20,835 (2017-2019) to $16,704 (2022-2023) per patient. Similarly, total weighted median ICANS management costs decreased by 34% ($10,503 to $6,977). The management costs associated with severe (Grade >3) CRS and ICANS were reduced by 74% and 32%, respectively.
CONCLUSIONS: This assessment demonstrated a reduction in AE management costs over time due to a lower incidence of severe AEs. Improvements in AE management may reflect increased institutional experience with CAR-T therapies and greater proficiency in managing AEs. The lower incidence of severe AEs and associated costs underscores the reduced impact on healthcare systems, and costs may potentially decline further if the observed trends toward improved AE management and reduced AE rates continue.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE188
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology