Health care resource utilization and costs of patients with diffuse large B-cell lymphoma receiving chimeric antigen receptor T-cell therapies across different settings of care: A real-world data analysis.

Abstract

Chimeric antigen receptor T-cell (CAR T) therapies have transformed the management of relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Receiving CAR T infusion in the hospital may be limited by constrained capacity of hospitals. Emerging data have demonstrated the safety and feasibility of outpatient CAR T administration. There are limited real-world data on economic outcomes for inpatient and outpatient CAR T administration among patients with DLBCL. To describe all-cause health care resource utilization (HRU) and costs of patients with DLBCL receiving CAR T infusion in the outpatient setting relative to those infused in the inpatient setting within a commercially insured population within the United States. A retrospective cohort study was conducted leveraging IQVIA PharMetrics Plus Health Plans Claims database between January 2017 and March 2024. Patients with DLBCL who received a CAR T infusion were identified and indexed on the date of the earliest CAR T infusion observed. Patients with clinical trial participation or invalid CAR T cost data (30-day post-index all-cause or CAR T-related costs of <$250,000) were excluded. All-cause HRU and costs (including CAR T product costs) within 30 days following the index CAR T infusion were described, stratified by the index infusion setting of care. Subgroup analyses were performed for patients receiving axicabtagene ciloleucel (axi-cel). There were 508 patients receiving CAR T infusion and meeting all selection criteria. 442 patients had CAR T administered in the inpatient setting, and 66 had it in the outpatient setting. Axi-cel was the most observed DLBCL-specific CAR T product (n = 223), and 10.3% received it in the outpatient setting (n = 23). Within 30 days following CAR T infusion, 48.5% of the outpatient cohort and 60.9% of patients receiving axi-cel in the outpatient setting had an inpatient stay, with lower rates of intensive care unit admissions (overall: 18.2% vs 43.9%; axi-cel: 39.1% vs 43.5%) and shorter median inpatient stays (overall: 9.0 vs 15.0 days; axi-cel: 11.0 vs 15.0 days) than the inpatient cohort. The mean total 30-day costs appeared lower in the outpatient cohort, overall ($643,902 vs $691,771) and for axi-cel ($695,904 vs $741,449). DLBCL CAR T products were administered predominantly in the inpatient setting. For overall CAR T products for DLBCL and axi-cel, patients receiving CAR T administration in the outpatient setting tended to have lower inpatient service utilizations and lower costs relative to those receiving it in the inpatient setting, suggesting that outpatient CAR T administration may help address capacity constraint and economic burden of CAR T delivery.