Effects of CD19 CAR T-cell therapy on quality of life and direct health care costs in SLE: a preliminary analysis.

Abstract

OBJECTIVE Patients with systemic lupus erythematosus (SLE) require long-term treatment and experience reduced quality of life (QoL). CD19 chimeric antigen receptor (CAR) T-cell therapy can achieve sustained drug-free remission in patients with SLE. The impact of CAR T-cell therapy on QoL and direct health care costs has not been evaluated. Here, we analyzed longitudinal QoL before and after CAR T-cell therapy and performed an assessment of direct health care costs. METHODS Physical and mental health was assessed using the standardized Short Form (SF)-36 before and one year after treatment. Annual direct health care costs were analyzed based on inpatient admissions, emergency department visits, outpatient visits and prescription drug costs in the German health care service. RESULTS A preliminary analysis was conducted on 8 patients with SLE (7 women, 1 man; age range 19-38 years) who received CAR T-cell therapy and were followed for over two years. CAR T-cell therapy resulted in improvement in the QoL in all patients. The most notable improvement was observed in physical health (from 22.4% to 75.5%), while mental health also improved (from 24.7% to 63.0%). QoL values rose to the level of a healthy comparison cohort. Additionally, CAR T-cell therapy led to a substantial decrease in annual direct health care costs from 29.672 €/year to 3.094 €/year after treatment. CONCLUSION In addition to clinical efficacy, in this preliminary cohort CD19 CAR T-cell treatment improves Qol in SLE patients and may substantially reduces the direct socioeconomic burden associated with active disease by over 90%.