Prime Therapeutics' study shows total cost of care for CAR-T plus post-treatment events can exceed $1 million

A real-world look at all treatment costs for large B-cell lymphoma illustrates need for close financial management

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Apr 12, 2021, 09:00 ET

EAGAN, Minn., April 12, 2021 /PRNewswire/ -- Blue Cross and Blue Shield plans can better forecast and manage the total cost of chimeric antigen receptor T-cell (CAR-T) therapies for members with relapsed or refractory B-cell lymphoma by putting Prime Therapeutics LLC (Prime) insights into action. Although CAR-T product to treat B-cell lymphoma wholesale acquisition cost is $373,000, real-world data from a recent Prime study showed the total cost for members receiving CAR-T therapy (Kymriah^® or Yescarta^®) averaged more than $700,000, and in some cases exceeded $1 million. Given the increased use of this emerging therapy, it's crucial payers understand the real-world total financial impact of the drug's use and the costs that arise from post-treatment cancer care. An analysis like this requires the integrated medical and pharmacy claims data and health services research expertise that Prime provides.

Over 2.5 years, Prime researchers looked at 74 members receiving treatment for B-cell lymphoma. Two assessments were performed, one evaluated the CAR-T treatment episode costs beginning 30 days prior to CAR-T administration through 56 days after CAR-T administration, and a second evaluated post-treatment clinical outcomes beginning 56 days after CAR-T administration.

To form a complete picture of the total B-cell lymphoma treatment course, the study authors also looked at events members experienced after receiving CAR-T therapy – such as chemotherapy and transplants. Prime's real-world data showed 39% of members did not have a durable CAR-T response, with chemotherapy being the most common event (30%) and 1 in 20 going on to have a bone marrow transplant. The total cost of care from members during the initial CAR-T therapy period ranged from $350,000 to more than $2 million. The cost for CAR-T treatment medication alone was $527,000 on average – roughly three-fourths (74%) of the total cost during the initial treatment period. However, 12% of people with post-CAR-T events incurred more than $1 million for their total cost of care (includes drug and other costs, such as infusion center visits or transplants).

Many new cancer medications are in discovery, and while outcomes for members with cancer are steadily improving, the cost of this improved care is dramatically increasing.¹ In 2020 alone, manufacturers won approval from the U.S. Food and Drug Administration (FDA) for 38 oncology-related drugs.² Prime's real-world evidence fills a void where little has been published to date about the costs of post-CAR-T clinical events and the impact on total cost to treat members with B-cell cancers.

"CAR-T therapies represent an incredible advancement in treating B-cell cancers," said Joseph Leach, M.D., senior vice president and chief medical officer for Prime. "Given the cost and toxicity of these treatments, we need better information to understand who derives durable benefit as well as how to best treat those who progress following therapy. Real-world evidence like this study will help us see how much value members are getting from treatments over time and inform treatment decisions by our clients and physicians. Prime's leadership on studies like this is opening doors for conversations with manufacturers and providers to get therapies with the most value to members."

A 2018 Institute for Clinical and Economic Review (ICER) report estimated the cost-effectiveness of the two CAR-T therapies in B-cell cancers and suggested the therapies are priced in alignment with their clinical value despite their high price. According to the report, the cost-effectiveness of both CAR-T therapies fell near or within commonly cited thresholds of $100,000-$150,000 per quality-adjusted life years (QALY) – a measure of the quality and quantity of life lived after medical treatment. Because ICER's study only estimated total treatment cost, Prime's real-world evidence is another barometer to consider when evaluating whether CAR-T's pricing is in line with the value it provides to members.

This silver award winning study will be presented at the Academy of Managed Care Pharmacy (AMCP) Virtual Annual Meeting April 12-16, 2021.

Polite BN, Ratain, MJ, Lichter AS. Oncology's "Hockey Stick" Moment for the Cost of Cancer Drugs-The Climate Is About to Change. JAMA Oncology 2021;7(1):25-26. https://jamanetwork.com/journals/jamaoncology/article-abstract/2771013
American Society of Clinical Oncology. https://ascopost.com/issues/december-25-2020/2020-fda-approvals-of-drugs-for-cancer-treatment/#:~:text=In%202020%2C%20the%20FDA%20approved,combinations%20such%20as%20ramucirumab%2Ferlotinib%2C Accessed March 29, 2021.

About Prime Therapeutics

Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves nearly 33 million people. It is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. For more information visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.

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SOURCE Prime Therapeutics LLC