Total Car-T Cost of Care Beyond the Price of Car-T Cell Therapy in Patients with Multiple Myeloma
Authors: Jagannath Sundar , Joseph Nedra , Crivera Concetta , Jackson Carolyn C. , Valluri Satish , Cost Patricia , Phelps Hilary , Slowik Rafal , Klein Timothy , Yu Xueting , Smolen Lee , Cohen Adam D 
Published: November 2021

Abstract
Background:
Chimeric antigen receptor T (CAR-T) cell therapy is a recent treatment option for triple-class exposed relapsed refractory multiple myeloma (RRMM) patients, who have previously received proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. In addition to CAR-T cell therapy acquisition costs, there are expected CAR-T healthcare costs separate from the cost of the CAR-T cell therapy itself. Identification and quantification of these costs have not previously been fully investigated. Healthcare payers, hospitals, and physicians need this important cost information in order to make informed healthcare decisions.
Objective:
The objective of this study was to quantify CAR-T therapy associated healthcare costs, i.e., costs aside from CAR-T therapy acquisition costs, associated with use of CAR-T therapy in RRMM patients.
Methods:
RRMM CAR-T clinical trial data and published literature, including peer-reviewed publications and conference presentations, were used for identification of these additional healthcare cost components. Inclusion/exclusion of additional cost components was based on previously published oncology pharmacoeconomic studies and input from key opinion leaders (KOLs) with expertise in the treatment of RRMM patients.
The study categorized costs for RRMM patients who receive the CAR-T infusion. Costs were categorized as pre-infusion, peri-infusion (excluding CAR-T therapy acquisition costs), and post-infusion costs. Pre-infusion costs included evaluation costs, apheresis costs, bridging therapy costs, and conditioning therapy costs. Peri-infusion costs included either inpatient or outpatient infusion costs. Post-infusion costs included 100-day post-infusion monitoring costs, additional infusion monitoring costs in the first year, and management of serious adverse event (AE) costs associated with the CAR-T therapy. Serious AEs included AEs that require or prolong hospitalization or result in death.
CAR-T acquisition costs are known and readily accessible, but this is not the case for other costs associated with CAR-T therapy, i.e., the pre-, peri-, and post-infusion costs. The costs must be individually calculated utilizing CAR-T clinical trial data, medical resource costs and utilization, and AE costs and rates. Based on a targeted literature review, there are sufficient data in the public domain to quantify the component additional costs, however there are no publications quantifying the entirety of these costs specifically in RRMM patients receiving CAR-T. Methodology was developed for derivation of these costs, which comprise an important and consequential portion of the total CAR-T therapy costs.
Results:
The RRMM patient pre- and peri-infusion CAR-T healthcare cost, aside from CAR-T therapy acquisition costs, was estimated to be $15,478. The components of this cost were apheresis ($112), bridging therapy ($8,570), conditioning therapy ($3,435), and a single day of inpatient infusion ($3,362). The post-infusion costs (including additional inpatient hospital days, AE management, and monitoring costs) are dependent on the types and rates of AEs associated with CAR-T therapy. These results will be presented at the ASH 2021 meeting.
Conclusions:
This study developed a methodology for the categorization, quantification, and calculation of the important healthcare costs, aside from CAR-T therapy acquisition costs, associated with the use of CAR-T in triple-class exposed RRMM patients. This information has been lacking in the literature and the analysis provides valuable, holistic information that key stakeholders require to make informed decisions.

Disclosures
Jagannath: Bristol Myers Squibb: Consultancy; Janssen Pharmaceuticals: Consultancy; Karyopharm Therapeutics: Consultancy; Legend Biotech: Consultancy; Takeda: Consultancy; Sanofi: Consultancy. Joseph: Johnson and Johnson: Current Employment, Current equity holder in publicly-traded company. Crivera: Johnson & Johnson: Current Employment, Current equity holder in publicly-traded company. Jackson: Janssen: Current Employment; Memorial Sloan Kettering Cancer Center: Consultancy. Valluri: Janssen: Current Employment, Current equity holder in publicly-traded company. Cost: Johnson & Johnson: Current Employment, Current equity holder in publicly-traded company. Phelps: Johnson & Johnson: Current Employment, Current equity holder in publicly-traded company. Slowik: Johnson & Johnson: Current Employment, Current equity holder in publicly-traded company. Klein: Medical Decision Modeling Inc.: Current Employment. Yu: Medical Decision Modeling Inc.: Current Employment. Smolen: Medical Decision Modeling Inc.: Current Employment. Cohen: GlaxoSmithKline: Consultancy, Research Funding; Janssen: Consultancy; Takeda: Consultancy; Oncopeptides: Consultancy; BMS/Celgene: Consultancy; AstraZeneca: Consultancy; Genentech/Roche: Consultancy; Novartis: Research Funding.