THE HIDDEN COST OF WAITING: EARLIER CAR T ACCESS REDUCES 5-YEAR TOTAL SPENDING IN RELAPSED/REFRACTORY DIFFUSE LARGE B CELL LYMPHOMA
Author(s)
Marjan Zakeri, MD, PhD1, Samuel Wagner, MPharm, PhD2, Nehir Yapar3, Onur Baser, PhD4.
1Columbia Data Analytics, New York, NY, USA, 2Columbia Data Analytics, Newtown, PA, USA, 3Director of Data Science, Columbia Data Analytics, New York, NY, USA, 4City University of New York (CUNY), New York, NY, USA.
1Columbia Data Analytics, New York, NY, USA, 2Columbia Data Analytics, Newtown, PA, USA, 3Director of Data Science, Columbia Data Analytics, New York, NY, USA, 4City University of New York (CUNY), New York, NY, USA.
OBJECTIVES: To quantify the cost implications of delaying chimeric antigen receptor T-cell therapy (CAR T) in Relapsed/Refractory Diffuse Large B Cell Lymphoma (R/R DLBCL), comparing CAR T immediately after first-line Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP) failure versus after non-cellular bridging with tafasitamab-lenalidomide (a National Comprehensive Cancer Network (NCCN)-preferred exemplar) plus platinum-based salvage.
METHODS: A US payer-perspective, cohort-based semi-Markov model (1,000 patients; monthly cycles; 3- and 5-year horizons) compared two pathways: Earlier CAR T (directly after R-CHOP failure) and Delayed CAR T (tafasitamab-lenalidomide then salvage before CAR T). Six health states with time-in-state tunnel substates captured non-exponential hazards. Transition probabilities came from digitized Kaplan-Meier curves from clinical trials. Costs (wholesale acquisition basis: drug, CAR T procedural, non-drug utilization) are discounted 3% annually. Sensitivity analyses varied CAR T access (10-50%) and death fractions (±25%).
RESULTS: At 5 years and 25% access, Earlier cost $531,491 per patient vs $573,491 for Delayed, a $42,000 (7.3%) saving. First-line R-CHOP cost was identical; the difference arose from lower intermediate-line spend under Earlier ($99.2M vs $198.4M cohort), partly offset by higher CAR T and supportive-care cost ($76.0M vs $18.8M). Per-patient-per-month cost was essentially equal ($11,031 vs $11,039); the saving reflected fewer active-treatment person-months (48,180 vs 51,950), less time in treatment, not less costly months. Earlier reached CAR T more often (~88 vs 21 per 1,000). The 5-year savings were held across all scenarios (−$28,443 to −$51,069) but were conditional on horizon: at 3 years it narrowed to −$9,663 and reversed to +$7,138 at 50% access.
CONCLUSIONS: Earlier CAR T initiation was modestly less costly at a 5 years horizon than delaying through tafasitamab-lenalidomide and salvage, driven by less time in active treatment rather than lower cost of care, and conditional on horizon and access. Reducing payer-driven delays to CAR T may lower total payer costs.
METHODS: A US payer-perspective, cohort-based semi-Markov model (1,000 patients; monthly cycles; 3- and 5-year horizons) compared two pathways: Earlier CAR T (directly after R-CHOP failure) and Delayed CAR T (tafasitamab-lenalidomide then salvage before CAR T). Six health states with time-in-state tunnel substates captured non-exponential hazards. Transition probabilities came from digitized Kaplan-Meier curves from clinical trials. Costs (wholesale acquisition basis: drug, CAR T procedural, non-drug utilization) are discounted 3% annually. Sensitivity analyses varied CAR T access (10-50%) and death fractions (±25%).
RESULTS: At 5 years and 25% access, Earlier cost $531,491 per patient vs $573,491 for Delayed, a $42,000 (7.3%) saving. First-line R-CHOP cost was identical; the difference arose from lower intermediate-line spend under Earlier ($99.2M vs $198.4M cohort), partly offset by higher CAR T and supportive-care cost ($76.0M vs $18.8M). Per-patient-per-month cost was essentially equal ($11,031 vs $11,039); the saving reflected fewer active-treatment person-months (48,180 vs 51,950), less time in treatment, not less costly months. Earlier reached CAR T more often (~88 vs 21 per 1,000). The 5-year savings were held across all scenarios (−$28,443 to −$51,069) but were conditional on horizon: at 3 years it narrowed to −$9,663 and reversed to +$7,138 at 50% access.
CONCLUSIONS: Earlier CAR T initiation was modestly less costly at a 5 years horizon than delaying through tafasitamab-lenalidomide and salvage, driven by less time in active treatment rather than lower cost of care, and conditional on horizon and access. Reducing payer-driven delays to CAR T may lower total payer costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO73
Topic
Clinical Outcomes, Health Service Delivery & Process of Care
Disease
Oncology