Effects of CD19 CAR T Cell Therapy on Quality of Life and Direct Healthcare Costs in Systemic Lupus Erythematosus: A Preliminary Analysis.

Abstract

Patients with systemic lupus erythematosus (SLE) require long-term treatment and experience reduced quality of life (QOL). CD19 chimeric antigen receptor (CAR) T cell therapy can achieve sustained drug-free remission in patients with SLE. The impact of CAR T cell therapy on QOL and direct healthcare costs has not been evaluated. Here, we analyzed longitudinal QOL before and after CAR T cell therapy and performed an assessment of direct healthcare costs. Physical and mental health were assessed using the standardized 36-item Short Form Health Survey before and 1 year after treatment. Annual direct healthcare costs were analyzed based on inpatient admissions, emergency department visits, outpatient visits, and prescription drug costs in the German healthcare service. A preliminary analysis was conducted on 8 patients with SLE (7 female, 1 male; age range 19-38 years) who received CAR T cell therapy and who were followed for > 2 years. CAR T cell therapy resulted in improvement in the QOL in all patients. The most notable improvement was observed in physical health (from 22.4% to 75.5%), although mental health also improved (from 24.7% to 63%). QOL values rose to the level of a healthy comparison cohort. Additionally, CAR T cell therapy led to a substantial decrease in annual direct healthcare costs from €29,672/year (US $34,353/year) to €3094/year ($3582/year) after treatment. In addition to clinical efficacy, in this preliminary cohort, CD19 CAR T cell treatment improves QOL in patients with SLE and may substantially reduce the direct socioeconomic burden associated with active disease by > 90%.