CAR-T therapies represent a new therapeutic approach, potentially to several diseases, but initially in cancer. CAR-T stands for chimeric antigen receptor T cells. T cells are one component of the immune system and the therapy takes T cells from a patient and modifies the receptor on those T cells to recognize tumor cells. When reinfused in the patient, these modified T cells kill the cancer. While potentially a dramatic improvement in patient care, both the product and services component of these therapies are incredibly expensive. CAR-T therapies have been approved for treatment of diffuse large B-cell non-Hodgkin lymphoma and Medicare covers the therapy. A recent poster paper presented at the American Society of Hematology describes early results in Medicare patients. (ASH Poster) Treatment of 177 Medicare patients, all fee-for-service, was included. Average costs per patient in the period before the CAR-T infusion and the period after were compared, as well as the amounts paid for the therapy itself.
The average age of the patients was 70. Most had multiple comorbidities and 43% had one or more comorbidities that would have disqualified them from receiving the therapy in the clinical trials used to gain approval. Half of the patients had a prior course of intravenous chemotherapy but less than 5% had undergone an autologous bone marrow transplant. The patients spent an incredible median of 16 days in the hospital during the CAR-T treatment and 45.5% ended up with an ICU stay after the infusion. A little over a quarter of the patients who had a hospitalization before the treatment also had one after discharge for the treatment. The rate of emergency room use in the 100 days after treatment was about half what it was before treatment. Not including the treatment costs, average health care costs in the 6 months before treatment were $58,820 and in the 100 days post-treatment were $23,738. On a per member per month basis this is an average decline of less than 20%. The authors seem to be trying to imply that there is some reduction in spending due to the CAR-T therapy. This is misleading, as the treatment costs are huge. The authors are all funded by the drug companies which create the product and nowhere in the paper do they tell you the treatment costs. So I will. Medicare is paying anywhere from $500,000 to a million dollars for the full cost of one of these treatments. Commercial payers are likely paying even more. So for them to produce any real net savings is almost impossible. These treatments are likely good for patients but will become ground zero in concerns about excessive pricing.