ASH Preview: The Costs of CAR-T

I saw my first television commercial for a CAR-T treatment recently. It kind of confused me a little bit, but then, most ads for cancer treatments have that affect on me. It's customary in the U.S. to include an "ask your doctor about...." statement in those ads, as if most of the population just casually brings those things up during doctor appointments ("My elbow hurts when I raise my coffee mug. Hey, what's this CAR-T stuff I saw an ad for when I was watching that rerun of Modern Family?")

But that's the way it is with our healthcare system. I have no idea if other countries, who have single-payer healthcare systems, even have such things as television ads for pharmaceutical treatments. I'm guessing you do not.

But I was thinking of that when I read an abstract for an ASH presentation called "4859 Total Costs of Care during Chimeric Antigen Receptor T-Cell Therapy in Patients with Relapsed/Refractory B Cell Non-Hodgkin Lymphoma: A Large Private Insurance Claim-Based Analysis."

CAR-T has been probably the most talked about, and most promising, blood cancer treatment in the nearly 15 years since I was diagnosed. It gets people very excited. At this year's ASH conference, there will be about 350 presentations related to CAR-T in some way. It's a big deal, as I'm sure you all know.

But one of the big criticisms of CAR-T has been the price. The treatment is developed by removing some T cells from a patient, changing them in a lab so they'll recognize cancer cells as something to be eliminated, and then put back into the patient. So each patient has their very own, personalized treatment made specially for them. So it's an expensive process, much more expensive than a treatment that can be made for thousands of people.

This ASH presentation looked at the private insurance records of patients who had received CAR-T and added up the costs. When CAR-T treatments were first approved, the manufacturers estimated that the treatment would cost roughly $450,000. (If you're not in the U.S., you can use this currency converter so you get a sense of the cost. Hint: it will be a lot.) But that $450,000 is just the price for the treatment itself. The researchers for this study also looked at all of the other costs related to the treatment, all of which were paid for by the private insurance: inpatient, outpatient, professional and associated drug costs. In other words, the costs for the doctor appointments before treatment, the costs of the drugs that help with side effects, separate fees for specialists that need to be consulted, etc. 

What they found was that the mean total cost was $618,100, and the median was $573,300. Nearly 6% of patients had a total cost of over $1,000,000. There weren't many FL patients in the study (only 6, compared to 269 with DLBCL), and their costs were higher ($611,900 for DLBCL, and $743,100 for FL).

And while the numbers are high, and awful, for patients in the U.S., this is a problem for all of us, no matter where we live: even single-payer systems will have to prioritize treatments, and make sure the effectiveness is worth the cost, or if some other treatment will a better, more cost-effective choice. 

So what's the alternative? Well, possibly an "off-the-shelf" or Allogeneic CAR-T. In other words, instead of making a personalized treatment for each patient, there could possibly be one CAR-T that could be effective for all patients. There are a number of Allo CAR-T treatments in development, including one called CB-010, which is getting an update at ASH.

One of the exciting things about ASH (and ASCO in the spring) is getting to see the small improvements that are made in treatments that have been around for a while. As great as CAR-T is, there's still lots of room for improvement, so hopefully we'll see more ways of getting this treatment to people soon.

I'm still reading. I'll post more interesting ASH presentations soon.