OBJECTIVES: The treatment landscape has dramatically changed for patients with relapsed or refractory large B-cell lymphoma (R/R LBCL) since the introduction of CD19 chimeric antigen receptor T-cell (CAR T) therapy. However, limited availability of CAR T centers in the Gulf Cooperation Council (GCC) area has necessitated healthcare abroad referrals for eligible patients. The aim of this study was to assess projected economic consequences of adopting CAR T referral pathways to the Kingdom of Saudi Arabia (KSA) compared to referrals to the United States (US) or Europe for R/R LBCL patients in the GCC.

METHODS: A cost-consequence analysis was conducted to compare referral scenarios. The model incorporated annualized direct medical costs (drug acquisition, administration, and resource utilization costs) and direct non-medical costs including transportation and daily allowances. Number of patient referrals, resource utilization and treatment-related costs (reported in USD) were sourced from medical bills, public formularies, business centers, and local clinical experts. One-way sensitivity analyses were conducted to account for uncertainty in input parameters.

RESULTS: Over a 1-year period, 14 R/R LBCL patients were referred abroad from GCC countries at an average per patient cost of $1,689,945 including $519,572 for drug acquisition, $1,088,175 for direct medical care, and $82,198 for non-medical costs. Comparable average per patient costs for referral to KSA were estimated at $636,751(drug acquisition: $436,810; direct medical: $162,667; direct non-medical: $37,274). Despite observing some minor referral cost variations across individual GCC countries, utilizing healthcare abroad referral pathways to KSA may help GCC health authorities realize substantially reduced referral expenditures for CAR T-eligible patients with R/R LBCL.

CONCLUSIONS: These findings suggest that CAR T referral to KSA is a cost-efficient approach for GCC countries compared to referrals to the US or Europe. Adoption of KSA referrals could potentially enable more patients within the GCC to receive treatment with the same budget spending.