Two posters presented at GCAP Nexus 2021 analyzed the costs of treating cytokine release syndrome and neurological events, 2 common adverse events (AEs) of chimeric antigen receptor (CAR) T cell therapy.
Chimeric antigen receptor (CAR) T cell therapies, such as tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (aix-cel), have dramatically improved outcomes for patients with diseases such as lymphoma diffuse large B-cell (DLBCL). However, these therapies are not free from adverse events (AEs) and additional costs related to the use of health resources (HRU). Two recent posters presented at GCAP Nexus 2021 examined the costs of these AEs.
The first poster summarized information from 4 real-world evidence studies of tisa-cel and axi-cel to quantify associated costs.1), as well as pharmacy services.
Of the 4 studies (published in 2019 and 2020), between 1% and 4% of patients receiving tisa-cel and between 7% and 16% of patients receiving axi-cel experienced grade cytokine release syndrome (CRS). â¥ 3. Between 0% and 5% of patients receiving tisa-cel and between 20% and 35% of patients receiving axi-cel experienced grade â¥3 neurotoxicity events.
Up to 20% of patients on tisa-cel and up to 71% of patients on axi-cel were using tocilizumab, which is used to treat CRS. As other research has shown, axi-cel was much more likely to be infused as part of PI (92% -100%) compared to tisa-cel (36%), in addition to days median hospitalizations were higher for axi-cel (15-16 days vs. 2 days). During the 28 days following the infusion, the median number of OP visits for tisa-cel was 6 versus 4 for axi-cel.
While the median days in intensive care were similar among the 2 therapies (4 days for tisa-cel and 5 days for axi-cel), only 7% of patients treated with tisa-cel were transferred to intensive care compared to 28% in 38% of patients on axi-cel.
Overall, the costs associated with axi-cel were significantly higher than with tisa-cel:
- $ 5,979 to $ 10,878 for total estimated patient management costs for axi-cel versus $ 843 to $ 1,962 for tisa-cel
- $ 32,394 to $ 33,166 for estimated total URH costs per patient for axi-cel versus $ 3,321 for tisa-cel
âThe additional cost burden for axi-cel was mainly due to the increase in intensive care and hospitalizations due to a higher proportion of IP infusion among the [patients] receiving axi-cel â, the authors concluded.
A second poster estimated the total cost to CRS patients and neurological events (EN) for patients with large B-cell lymphoma (LBCL) treated with axi-cel, tisa-cel or lisocabtagene maraleucel (liso- cel). 2
The authors developed a model incorporating the adverse effects of CRS and NE using data from the TRANSCEND NHL 001, ZUMA-1 and JULIET clinical trials. They found:
- The overall weighted average cost per patient was $ 18,718 for liso-cel, $ 47,665 for axi-cel and $ 42,538 for tisa-cel
- The weighted average cost per CRS patient was $ 8,213 for liso-cel, $ 20,442 for axi-cel and $ 26,009 for tisa-cel
- The weighted average cost per patient per NE was $ 10,505 for liso-cel, $ 27,223 for axi-cel and $ 16,528 for tisa-cel
The lower cost of potentially managing CRS and NE for liso-cel was due to the lower rates, according to the authors.
“These results highlight the economic implications of the safety differences between CAR T cell therapies,” the authors concluded.
1. Lim S, Bollu V, Dalal A, et al. Estimation of Adverse Event (AE) Costs and Health Resource Use (HRU) in Patients (pts) with Relapsed or Refractory Diffuse Large B Cell Lymphoma (LDGCB r / r) Receiving Tisagenlecleucel and axicabtagene ciloleucel in a real context. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, Colorado. Abstract C38.
2. Badaracco J, Keating S, Gitlin M. Updates of an economic model for estimating the costs of cytokine release syndrome (CRS) and neurological events (NE) with T cell receptor therapies chimeric antigen (CAR) in relapsed patients (Pts) or refractory large b-cell lymphoma (LBCL) (R / R). Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, Colorado. Abstract D13.