Is Outpatient Administration of Liso-Cel Cost Efficient for Patients with CLL?

Outpatient administration of lisocabtagene maraleucel (liso-cel) “may be a cost-efficient option” in patients with relapsed or refractory chronic lymphocytic leukemia (CLL), according to a study presented during the Eleventh Annual Meeting of the Society of Hematologic Oncology.

November McGarvey, PhD, of BluePath Solutions, and colleagues conducted the research because while patients receiving chimeric antigen receptor (CAR) T-cell therapy are “generally treated in the inpatient setting, opportunities for outpatient administration to reduce costs exist.” However, health care resource utilization and monitoring costs after a patient receives CAR-T “may differ” by the site of care, they wrote.

Estimating Costs of Inpatient, Outpatient CAR-T Administration

The researchers aimed to estimate the one-year postinfusion health care resource utilization and costs by site of care among 108 patients with relapsed or refractory CLL who received liso-cel in the TRANSCEND trial.

Dr. McGarvey and colleagues analyzed individual patient-level case report forms from TRANSCEND that included details about health care resource utilization in the year following CAR-T infusion. The health care resource utilization cost categories included facility, diagnostics, procedures, and medications but excluded liso-cel acquisition costs. The researchers sourced unit costs from public databases and the literature and calculated the costs for each health care resource utilization category, adjusted to 2023 US dollars.

They classified patients as receiving inpatient care if they had an overnight hospital stay and classified those who were discharged the same day of liso-cel infusion as receiving outpatient care. The researchers stratified all outcomes by site of care and month.

Dr. McGarvey and colleagues found that 87% of patients received inpatient care, while 13% received outpatient care. The mean age of those receiving inpatient care was 64.2 years, while the mean age was 65.1 years in those receiving outpatient care. The researchers reported that 16% of those receiving inpatient care had a stay in the intensive care unit (ICU), while 7.1% receiving outpatient care had an ICU stay. The median total hospital length of stay was 18 days for those receiving inpatient administration and it was 14 days for those receiving outpatient administration.

Nearly all patients received antibiotics (inpatient, 98.9%; outpatient, 92.9%) and most received tocilizumab (inpatient, 69.1%; outpatient, 57.1%), and corticosteroids (inpatient, 67.0%; outpatient, 42.9%).

The estimated median one-year total postinfusion monitoring costs were $82,382 for those receiving inpatient administration and $38,398 for those receiving outpatient administration.

The researchers found that facility costs were the “primary cost driver.” The inpatient facility costs were $27,752, making up 34% of the total costs for patients receiving inpatient administration. The outpatient facility costs were $20,043, making up 52% of the costs for those receiving outpatient administration. Most of the median total one-year costs occurred in the first month after infusion, with a median of $48,527 for those receiving inpatient administration and $28,778 for those receiving outpatient administration.

“Despite the small sample size of outpatients, these findings suggest that outpatient administration of liso-cel in patients with [relapsed or refractory] CLL may be a cost-efficient option due to the lower total one-year post-infusion costs and reduced [health care resource utilization] versus inpatients,” Dr. McGarvey and colleagues concluded.

Reference

McGarvey N, Lee A, Imanak K, et al. Post-infusion monitoring costs and health care resource utilization (hcru) by site of care (soc) in patients with relapsed or refractory (r/r) chronic lymphocytic leukemia (CLL) receiving lisocabtagene maraleucel (liso-cel) treatment in the TRANSCEND CLL 004 (TRANSCEND) study. Abstract CT-105. Presented at the Eleventh Annual Meeting of the Society of Hematologic Oncology; September 6-9, 2023; Houston, Texas.