OBJECTIVES: Chimeric antigen receptor T cell (CAR-T) therapy is now being provided more than ever across new indications, and further expansion is expected in the coming years. Current published work on mortality and treatment success consists of meta-analyses and single-system retrospective studies. Research has not fully evaluated mortality across multiple payers and patient demographics.

METHODS: The Medicare 100% Research Identifiable Files (2017-2022), 100% Medicaid Advantage Encounters claims (2017-2020), and 100% Medicaid T-MSIS (2017-2020) were assessed for CAR-T administration in the inpatient and outpatient setting. Date of death and other demographic information was identified in the Medicare Beneficiary Summary File (MBSF) and TAF Demographic and Eligibility File. Patients were selected for the analysis if they had their first CAR-T procedure between January 2017 and April 2022, which allowed evaluation of mortality six months after their index event.

RESULTS: We identified 4,199 beneficiaries’ first CAR-T treatment. The overall six-month mortality rate was 22%. Over time, the mortality rate has fluctuated, but we see a significant decrease across the five-year period: 31% in 2017 to 17% in 2022. No significant difference was found across beneficiaries in the three payment systems (Medicare Fee for Service – 22%; Medicare Advantage – 22%; Medicaid – 19%). Males (31%) had significantly higher mortality than female (24%). Also, beneficiaries receiving CAR-T in the inpatient setting was significantly higher (22%) compared to outpatient setting (16%). Other variables assessed: race, average age, and time to death.

CONCLUSIONS: While CAR-T therapy is a relatively new therapy given the small number of beneficiaries, the volume of patients now available for analysis has the statistical power for more complex predictive analyses. Predictors of treatment success can now be identified which can aid in CAR-T being utilized across a wider patient population and in multiple settings of care.