CRANBURY, N.J.--(BUSINESS WIRE)--Potentially curative cancer treatments, like chimeric antigen receptor (CAR) T-cell therapies, have revolutionized care for illnesses once thought to be a death sentence after relapse, such as pediatric acute lymphoblastic leukemia (pALL) and diffuse large B-cell lymphoma (DLBCL). While 2 approved treatments are available (tisagenlecleucel and axicabtagene ciloleucel), therapy initiation is often delayed due to payment processes—in fact, it was only this month that the Centers for Medicare and Medicaid Services released a long-awaited payment decision for Medicare beneficiaries with cancer in need of treatment with CAR T-cell therapy as well as a boost in hospital payment rates. In a new study in the current issue of The American Journal of Managed Care® (AJMC®), researchers defined the concept of the social value that these potentially curative therapies provide, but they caution that treatment delays caused by a lack of payment mechanisms and policies are limiting the potential impact of these treatments.
The issue stems from the fact that one-time CAR T-cell therapies, and even more costly upcoming gene therapies, are a challenge to existing US payment structures; their costs accrue up front, in contrast with other cancer drugs that are given—and paid for—over an extended time period.
Using an economic framework, researchers measured the social value of CAR T-cell therapy for relapsed or refractory pALL and DLBCL. Social value analyses were used to quantify a therapy’s economic value from a societal perspective and determine the share of that value accruing to the manufacturer and patients. Expanded patient access and greater health benefits increase social value, while higher production costs to develop the therapy reduce it.
Manufacturers have stronger incentives for innovation with a rising share of social value, but when treatment is delayed, social value is lost for both patients and manufacturers: Patients lose access to health improvements and manufacturer profit is reduced.
The study found that CAR T-cell therapy generated up to $6.5 billion and $34.8 billion of social value for patients with pALL and DLBCL, respectively. However, with one, two and six months of treatment delay, patients with pALL lost 9.8 percent, 36.2 percent and 67.3 percent of social value, respectively; patients with DLBCL lost 4.2 percent, 11.5 percent and 46 percent of social value, respectively.
The degree of CAR T-cell therapy’s value depends on timely patient access, but the authors note that it is not unusual for CAR T-cell therapy reimbursement approval to take up to 90 days, which may be longer than a waiting patient may live. Given other high-cost therapies in the pipeline, lessons learned from CAR T-cell therapies can help payers, policy makers and manufacturers, the authors say.
“Our research shows that CAR T offers potentially large value for patients and society, but only if patients can access it promptly,” said lead study author Julia Thornton Snider, PhD. “It will be essential for all stakeholders to work together to ensure appropriate policies are in place to secure timely access for patients.”
The study was funded by Novartis, maker of tisagenlecleucel.
For the full study, click here.
About The American Journal of Managed Care®
The American Journal of Managed Care® (AJMC®) is a multimedia peer-reviewed, MEDLINE-indexed journal that keeps industry leaders on the forefront of health policy by sharing digital research relevant to industry decision-makers. Other brands in the AJMC® family include The American Journal of Accountable Care®, Evidence-Based Oncology™ and Evidence-Based Diabetes Management™. These comprehensive multimedia brands bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. AJMC® is a brand of MJH Life Sciences, the largest privately held, independent, full-service medical media company in the U.S. dedicated to delivering trusted health care news across multiple channels.