Healthcare resource use and reimbursement amount by site of care in patients with diffuse large B-cell lymphoma receiving chimeric antigen receptor T-cell (CAR-T) therapy – a retrospective cohort study using CMS 100% Medicare claims database

Abstract

Chimeric antigen receptor T-cell (CAR-T) infusion settings may impact healthcare resource use (HRU) and reimbursement amounts. Adults with diffuse large B-cell lymphoma receiving CAR-T therapy were identified from the Centers for Medicare & Medicaid Services (CMS) 100% fee-for-service Medicare database and stratified into inpatient (IP; n = 380) and outpatient (OP; n = 50) cohorts based on CAR-T infusion setting. During the first month post-infusion, OP cohort had significantly fewer IP visits, IP days, intensive care unit (ICU) stays, ICU days, and significantly more OP, emergency room (ER) visits, than IP cohort. In subsequent months, HRU became comparable between cohorts. Medicare reimbursement amounts during the first month post-infusion were nominally higher in the OP vs. IP cohort and comparable in subsequent months. The reimbursement amounts did not reflect the reduced HRU with OP infusions, potentially due to differences in Medicare payment policies for OP vs. IP services.

Keywords:

• Cell and gene therapy
• CAR-T
• tisagenlecleucel
• HRU
• Medicare
• reimbursement

Acknowledgements

Medical writing assistance was provided by Flora Chik, PhD, an employee of Analysis Group, Inc.

Author contributions

All authors were involved in the following aspects of the research: the conception and design of the study, or analysis and interpretation of the data; drafting of the paper and revising it critically for intellectual content; and the decision to submit the manuscript for publication. All authors agree to be accountable for all aspects of the work.

Disclosure statement

Vamsi Bollu, Stephen Lim, Mimi Tesfaye, and Anand A. Dalal are employees of Novartis Pharmaceutical Company and may own stock or stock options. Hongbo Yang, Angela Lax, and Sakshi Sethi are employees of Analysis Group Inc. and Jing Zhao is a former employee of Analysis Group Inc. and received payments from Novartis to conduct the research.

Additional information

Funding

Financial support for this study was provided by Novartis.