Following an important CAR-T clinical trial, researchers examined the reasons for patient exclusion and the survival rates of patients who were deemed eligible compared with those deemed ineligible. READ MORE

News

Following an important CAR-T clinical trial, researchers examined the reasons for patient exclusion and the survival rates of patients who were deemed eligible compared with those deemed ineligible.

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A cost-effectiveness analysis of CAR-T therapy for pediatric patients with relapsed or refractory leukemia showed an incremental cost-effectiveness ratio between $37,000 and $78,000 per QALY gained over a patient lifetime horizon.

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While the economic value of CAR-T therapy is uncertain, price reductions or payment aligned with long-term remission would favorably influence cost-effectiveness, according to a recent analysis.

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The American Society of Blood and Marrow Transplantation is likely to finalize a toxicity rating system for CAR-T therapies by the end of 2018, according to a recent report.

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Features

Before cellular therapies become standard outpatient procedures, many critical issues will need to be addressed, including coordination of care, availability of specific resources, education of patients and caregivers, and toxicity management—both clinical and financial toxicity.

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Authors review the foundational research in CAR-T therapy, including pricing estimates, in order to determine how best to integrate this new branch of immuno-oncology into clinical pathways for patients with B-cell malignancies.

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Author Insights

Will payers push for services to be provided on an outpatient basis, thus placing financial burden upon the patient, or will they allow the oncologist or facility to use their discretion as to where the infusion will take place?

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Bruce A Feinberg, DO, and Chadi Nabhan, MD, MBA, FACP, contend that collaboration between payers and other stakeholders will help amend the concerns regarding newly approved CAR-T therapies.

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While CAR T-cell therapies fill an unmet need in hematologic malignancies, they are not without risk and cost burdens, according to Winston Wong, PharmD.

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Interactive Features

What is the average cost per patient for additional therapy or adverse events after CAR-T therapy administration?

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A recent study found that patients with non-Hodgkin lymphoma who received CAR-T therapy benefited, with an overall response rate of what percentage after a median of 15.4 months?

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Interview

Michael R Bishop, MD, Director, Cellular Therapy Program, University of Chicago Medicine, explains the challenges providers face when navigating Medicare and Medicaid policy for administering CAR-T therapy as well as the future applications of cellular therapy.

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Nicole M Trask, PharmD, clinical consultant pharmacist, UMass Medical School, discusses the distinction between gene therapy and cell therapy as it relates to CAR-T products and the cost implications as more products come to the market.

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Gary Goldstein, Blood and Marrow Transplant Program, Stanford Health Care, describes the changes needed for increased CAR-T administration in the outpatient setting and both commercial and provider concerns about the latest reimbursement news.

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Russel J Spjut, PharmD, formulary management clinical pharmacist, consultant at Formulary Intel Consulting, discusses the innovative payment models likely to emerge for CAR-T and the long-term clinical value of these therapies.

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B-Cell Malignancies

A recent study attempted to determine the budget impact, from a payer’s perspective, of a cellular therapy for the treatment of relapsed or refractory DLBCL.

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Long-term survival for patients with symptomatic indolent lymphoma after treatment with chemotherapy-free first-line therapy may be superior to standard regimens and offer no major safety issues.

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A secondary analysis suggests that PET is a better imaging modality than contrast-enhanced CT for response assessment after induction immunochemotherapy in patients with follicular lymphoma.

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Researchers from a US hospital were able to reduce the time to chemotherapy administration for elective admissions by over 64% in an inpatient hematology malignancy unit.

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Resources

The National Comprehensive Cancer Network released updated guidelines for a variety of B-cell lymphomas, including follicular lymphoma, marginal zone lymphoma, mantle cell lymphoma, and diffuse large B-cell lymphoma.

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