OBJECTIVES: Recent therapeutic advances in oncology treatment include the development of CD19-targeted chimeric antigen receptor (CAR) T-cell therapies. The objective of this study is to assess health care resource utilization and associated costs required for the implementation of CD19-targeted CAR T-cell therapies in Canada.

METHODS: The CAR T-cell implementation process comprises two main phases, a site Qualification Phase, which includes a kick-off meeting, qualification audit, training, dry run, and risk management plan, and a Post-Qualification Phase comprised of patient enrolment, leukapheresis, cell processing, cryopreservation, infusion of CAR T-cells, patient monitoring, and patient follow-up. Healthcare resource utilization and costs for the qualification and post-qualification phases were based on the number of staff and resources needed, the time required at each step, and the unit costs associated with each identified healthcare resource. Ward and intensive care unit per diem costs were taken from the Canadian Institute for Health Information. Most costs considered in this analysis were from either Ontario or Quebec, and some slight variation may occur across provinces. The cost of CAR T-cell acquisition was not considered in the analysis as these costs are not currently publicly available. All included costs were adjusted to 2020 Canadian dollars (CADs).

RESULTS: The total cost of CD19-targeted CAR T-cell implementation was estimated to be $62,500 per patient in the first year, including approximately $10,800 and $51,700 for the Qualification and Post-Qualification phases, respectively. The cost of patient monitoring and follow-up for the five years following CAR T-cell administration was estimated at $17,160.

CONCLUSIONS: While implementation of CAR T-cell therapy is associated with substantial costs, the impact on patient survival and overall quality of life cannot be overlooked. Implementation of CAR T-cell therapies in the management of B-cell lymphomas in Canadian institutions could also pave the way for future cell therapies in other disease areas.