OBJECTIVES: To examine real-world safety outcomes and the impact of AEs on HRU and TCOC (product acquisition and postinfusion costs) among patients with LBCL receiving CAR T-cell therapy.

METHODS: This retrospective cohort analysis used data from 2 administrative claims databases: IBM^® MarketScan^® and Optum^® Clinformatics^® Data Mart. Adult patients with LBCL with a CAR T-cell infusion claim and continuous enrollment ≥6 months before and ≥3 months after infusion date were included. Postinfusion AEs were defined as claims for: any or severe (based on symptom severity) cytokine release syndrome (CRS) within 14 days; any neurologic event (NE) within 30 days; and prolonged cytopenia (≥2 hematologic AEs for >28 days; all grades) within 30 days of CAR T-cell therapy. We examined HRU from the infusion date to 3-months postinfusion using both databases; we compared TCOC using direct, paid costs from MarketScan^®.

RESULTS: Nineteen patients from MarketScan^® and 35 from Clinformatics^® met eligibility criteria (mean age, 55 vs 62 years; male, 79% vs 74%, respectively). In MarketScan^® and Clinformatics^®, respectively, 74% and 86% of patients experienced CRS, 16% and 23% experienced severe CRS, 58% and 74% experienced NE, and 68% and 83% experienced prolonged cytopenia. In MarketScan^® and Clinformatics^®, respectively, mean inpatient length of stay (LOS) was 17 and 21 days and hospital readmission rates were 32% and 37%. LOS was longest among patients with severe CRS (MarketScan^®: 29 days; Clinformatics^®: 28 days); readmissions were highest among patients with severe CRS (MarketScan^®: 67%) and prolonged cytopenia (Clinformatics^®: 45%). Per-patient TCOC in the 3-months postinfusion were $711,615 among patients with severe CRS, $465,544 in those with any-grade CRS and NE, and $485,065 in those with prolonged cytopenia.

CONCLUSIONS: In CAR T-cell treatment and management, HRU and TCOC are substantially impacted by severe AEs, which are associated with increased inpatient LOS and readmission rates.