PMID- 37774383
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20231024
IS  - 1424-3997 (Electronic)
IS  - 0036-7672 (Linking)
VI  - 153
DP  - 2023 Sep 29
TI  - Real-world expenditures and survival time after CAR-T treatment for large B-cell 
      lymphoma in Switzerland: a retrospective study using insurance claims data.
PG  - 3441
LID - 10.57187/s.3441 [doi]
AB  - AIM OF THE STUDY: Newly approved therapies with high and uncertain budget impact 
      pose challenges to public health care systems worldwide. One recent example is 
      chimeric antigen receptor T cell (CAR-T) therapies for adults with large B-cell 
      lymphoma (LBCL). This study's primary objective is to examine the expenditures of 
      Swiss public payers before, during, and after CAR-T cell therapy in patients with 
      LBCL aged >/=30 years. Its secondary objective is to analyse 24-month survival 
      rates. METHODS: This retrospective observational data analysis used the 
      administrative databases of the Swiss health insurers Concordia, CSS, Groupe 
      Mutuel, Helsana, OKK, Sanitas, SWICA, Sympany, and Visana. These health insurers 
      or groups provide mandatory health insurance to approximately 78% of Swiss 
      residents in 2021. Using the relevant procedure codes, we identified CAR-T 
      therapies administered between October 2018 (first approval) and June 2021 
      (treatment identification cut-off). Patients aged <30 years were excluded because 
      they might be treated for pediatric acute lymphoblastic leukaemia. Expenditures 
      were categorised as pre-infusion, peri-infusion (excluding CAR-T therapy 
      acquisition costs), and post-infusion based on the time of service provision. 
      Overall survival rates were estimated using the Kaplan-Meier method. RESULTS: 
      This study identified 81 patients aged >/=30 years, with a median follow-up period 
      for censored observations of 27 months (interquartile range: 21-31 months). The 
      median age group was 70-74, and 60% of patients were male. Mean healthcare 
      expenditures per patient per month amounted to CHF 8,115-22,564 pre-infusion, CHF 
      38,490 peri-infusion, and CHF 5,068-11,342 post-infusion. For the total peri- and 
      post-infusion period (i.e. 1-month before infusion to 23 months after infusion), 
      mean healthcare expenditures amounted to CHF 215,737. The 24-month overall 
      survival rate was 48% (95% confidence interval: 38-61%). CONCLUSIONS: Healthcare 
      expenditures after CAR-T cell infusion are relatively high compared to previous 
      estimates of patients with LBCL in the last year of treatment. Further research 
      is needed to understand the drivers behind these post-infusion expenditures. 
      Especially, clinical data should be used to assess the time until disease 
      progression. The analysis of 24-month overall survival is consistent with results 
      from the pivotal trials. Our findings stress the importance of post-approval 
      studies to monitor real-world expenditures and outcomes related to innovative 
      therapies.
FAU - Trottmann, Maria
AU  - Trottmann M
AD  - SWICA Krankenversicherung AG, Winterthur, Switzerland.
FAU - Blozik, Eva
AU  - Blozik E
AD  - SWICA Krankenversicherung AG, Winterthur, Switzerland.
FAU - Hilbig, Marcel
AU  - Hilbig M
AD  - OKK Kranken- und Unfallversicherungen AG, Landquart, Switzerland.
FAU - LoVerdi, Daniel
AU  - LoVerdi D
AD  - SWICA Krankenversicherung AG, Winterthur, Switzerland.
FAU - Pedruzzi, Marcello
AU  - Pedruzzi M
AD  - Helsana Versicherungen AG, Dubendorf, Switzerland.
FAU - Scherer, Tina
AU  - Scherer T
AD  - Sanitas Grundversicherungen AG, Zurich, Switzerland.
FAU - Weiss, Martina
AU  - Weiss M
AD  - Helsana Versicherungen AG, Dubendorf, Switzerland.
FAU - Pletscher, Mark
AU  - Pletscher M
AD  - Berner Fachhochschule, Institut fur Gesundheitsokonomie und Gesundheitspolitik, 
      Bern, Switzerland.
FAU - Meier, Niklaus
AU  - Meier N
AD  - Berner Fachhochschule, Institut fur Gesundheitsokonomie und Gesundheitspolitik, 
      Bern, Switzerland.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20230929
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
RN  - 0 (Receptors, Chimeric Antigen)
SB  - IM
MH  - Adult
MH  - Child
MH  - Humans
MH  - Male
MH  - Female
MH  - *Receptors, Chimeric Antigen
MH  - Health Expenditures
MH  - Retrospective Studies
MH  - Switzerland
MH  - Immunotherapy, Adoptive
MH  - Insurance, Health
MH  - *Lymphoma, Large B-Cell, Diffuse
EDAT- 2023/09/29 18:42
MHDA- 2023/10/23 01:18
CRDT- 2023/09/29 16:43
PHST- 2023/10/23 01:18 [medline]
PHST- 2023/09/29 18:42 [pubmed]
PHST- 2023/09/29 16:43 [entrez]
AID - 3441 [pii]
AID - 10.57187/s.3441 [doi]
PST - epublish
SO  - Swiss Med Wkly. 2023 Sep 29;153:3441. doi: 10.57187/s.3441.