Health care resource utilization and costs of patients with diffuse large B-cell lymphoma receiving chimeric antigen receptor T-cell therapies across different settings of care: A real-world data analysis.

backgroundChimeric antigen receptor T-cell (CAR T) therapies have transformed the management of relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Receiving CAR T infusion in the hospital may be limited by constrained capacity of hospitals. Emerging data have demonstrated the safety and feasibility of outpatient CAR T administration. There are limited real-world data on economic outcomes for inpatient and outpatient CAR T administration among patients with DLBCL.

objectiveTo describe all-cause health care resource utilization (HRU) and costs of patients with DLBCL receiving CAR T infusion in the outpatient setting relative to those infused in the inpatient setting within a commercially insured population within the United States.

methodsA retrospective cohort study was conducted leveraging IQVIA PharMetrics Plus Health Plans Claims database between January 2017 and March 2024. Patients with DLBCL who received a CAR T infusion were identified and indexed on the date of the earliest CAR T infusion observed. Patients with clinical trial participation or invalid CAR T cost data (30-day post-index all-cause or CAR T-related costs of <$250,000) were excluded. All-cause HRU and costs (including CAR T product costs) within 30 days following the index CAR T infusion were described, stratified by the index infusion setting of care. Subgroup analyses were performed for patients receiving axicabtagene ciloleucel (axi-cel).

resultsThere were 508 patients receiving CAR T infusion and meeting all selection criteria. 442 patients had CAR T administered in the inpatient setting, and 66 had it in the outpatient setting. Axi-cel was the most observed DLBCL-specific CAR T product (n = 223), and 10.3% received it in the outpatient setting (n = 23). Within 30 days following CAR T infusion, 48.5% of the outpatient cohort and 60.9% of patients receiving axi-cel in the outpatient setting had an inpatient stay, with lower rates of intensive care unit admissions (overall: 18.2% vs 43.9%; axi-cel: 39.1% vs 43.5%) and shorter median inpatient stays (overall: 9.0 vs 15.0 days; axi-cel: 11.0 vs 15.0 days) than the inpatient cohort. The mean total 30-day costs appeared lower in the outpatient cohort, overall ($643,902 vs $691,771) and for axi-cel ($695,904 vs $741,449).

conclusionsDLBCL CAR T products were administered predominantly in the inpatient setting. For overall CAR T products for DLBCL and axi-cel, patients receiving CAR T administration in the outpatient setting tended to have lower inpatient service utilizations and lower costs relative to those receiving it in the inpatient setting, suggesting that outpatient CAR T administration may help address capacity constraint and economic burden of CAR T delivery.