Economic evaluation of critically ill adult CAR-T cell recipients-analysis from a healthcare payer perspective.

Background: CAR-T cell (chimeric antigen receptor T) therapy is now part of standard of care treatment of B‑cell lineage malignancies. Although it is an effective treatment, it comes along with adverse side effects and toxicities that may require intensive care therapy. The costs related to critical care therapy in critically ill patients after CAR‑T administration have not been evaluated.

Patients and methods: Retrospective analysis of all patients who had received CAR‑T therapy and were admitted to the intensive care unit (ICU) of a tertiary care university medical centre in Germany between 1 January 2019 and 31 December 2022. Cause of admission and ICU therapy as well as treatment and total hospitals costs were evaluated.

Results: Thirty patients with a history of CAR-T cell therapy for underlying haematological malignancy were included. The median age of all patients was 60 years (interquartile range [IQR] 50-70) and 37% (n = 11) were female. 93% (n = 28) of patients had non-Hodgkin lymphoma and 7% (n = 2) had multiple myeloma. The cohort was stratified whether the ICU admission was CAR‑T therapy related (i.e. within 30 days after CAR‑T therapy; 73%, n = 22) or the admission was of an other cause (> 30 days after CAR‑T therapy) (27%, n = 8). The median duration from CAR‑T therapy to ICU admission was 6 (range 5-8) days in CAR-T cell therapy associated ICU admissions compared with 52 (range 31-126) days in other admissions. The overall illness severity on admission was numerically higher in CAR-T-related ICU admission compared to other admissions (46 vs. 43 points, p = 0.18). Vasopressor therapy (50% vs. 75%; p = 0.19), invasive mechanical ventilation (27% vs. 50%; p = 0.24) and renal replacement therapy (14% vs. 50%; p < 0.05) were used in CAR-T-associated admission compared to other admissions, respectively. The ICU mortality (23% vs. 50%; p = 0.15) was higher in patients with other ICU admission. Median total costs of the entire inpatient stay in hospital were € 27,845 (range 8661-368,286 €) in CAR-T-associated ICU admissions compared to € 59,234 (range 23,182-127,044 €) in the group of other ICU admissions (costs of the CAR‑T product not included).

Conclusion: In relation to the total costs of CAR-T-cell therapy (production of the CAR‑T product), therapy-associated complications have a relatively low impact on the costs and utilization of ICU resources.