Abstract Introduction: Chimeric antigen receptor T-cell(CAR-T) therapies targeting B-cell maturation antigen are now established in the treatment landscape for multiple myeloma (MM); however, clinical decision-making may be influenced by real-world logistical and healthcare resource utilization (HCRU) considerations alongside treatment efficacy. A clearer understanding of HCRU with CAR-T therapies in MM is needed. Here we report the real-world demographics, administration-related HCRU, and post-administration HCRU of patients who received idecabtagene vicleucel (ide-cel) or ciltacabtagene autoleucel (cilta-cel). Methods: This retrospective cohort study used IQVIA PharMetrics Plus® Enhanced Closed Claims database. Included patients were adults with MM who were not participating in clinical trials and who had the first claim for ide-cel/cilta-cel within the relevant FDA-approved period (from Mar 1, 2021 for ide-cel and Feb 1, 2022 for cilta-cel). Continuous enrollment in medical and pharmacy benefits for ≥6 months before and ≥1 month after the first record of CAR-T administration (index date) was required. Patient demographics were evaluated in the 6 months prior to or on the index date. Administration-related HCRU was evaluated on the index date, and post-administration HCRU was evaluated in the 30 days following the index date. The study periods were from Sep 1, 2020 (ide-cel)/Aug 1, 2021 (cilta-cel) until Sep 30, 2024. Results: The ide-cel cohort included 89 patients and the cilta-cel cohort included 144 patients. Median (interquartile range) ages were 65 (59–70) years for ide-cel and 62 (57–68) years for cilta-cel, and most patients were male (62.9% ide-cel/67.4% cilta-cel). Both CAR-T therapies were most commonly administered in inpatient settings (83.1% ide-cel/52.8% cilta-cel), and most patients receiving each agent had an inpatient admission on the index date (92.1% ide-cel/58.3% cilta-cel). Mean (standard deviation SD) lengths of inpatient admission at index were 15.9 (13.3)/18.9 (19.6) days for ide-cel/cilta-cel. Intensive care unit (ICU) visits on index date were reported for 33.7%/20.1% of patients receiving ide-cel/cilta-cel, with a mean (SD) length of stay of 12.5 (13.4)/13.7 (7.7) days. In the 30 days post-administration, 7.9%/34.7% of patients receiving ide-cel/cilta-cel had ≥1 all-cause inpatient admission, with 4.5%/16.0% having an ICU stay, and 3.4%/10.4% having an emergency room (ER) visit. Patients treated with ide-cel/cilta-cel had mean (SD) inpatient stays of 9.7 (6.3)/6.9 (4.4) days and ICU stays of 8.8 (7.2)/7.2 (4.8) days. The most common diagnoses observed in the 30 days post ide-cel/cilta-cel administration were hematologic complications (65.2%/60.4%; including neutropenia, anemia, thrombocytopenia, and leukopenia), cytokine release syndrome (CRS: 60.7%/56.3%), and hypertension (49.4%/34.0%). Inpatient admissions related to hematologic complications/CRS/hypertension occurred in 47.2%/57.3%/43.8% of patients receiving ide-cel and 41.0%/53.5%/24.3% of patients receiving cilta-cel. Infections in the 30 days post ide-cel/cilta-cel administration occurred in 4.5%/8.3% of patients. Patients receiving ide-cel (24.7%) and cilta-cel (38.2%) were administered intravenous immunoglobulin (IVIG) from 6 months before the index date to 30 days after administration. Over the full study period, the majority of patients receiving ide-cel (64.0%) and cilta-cel (77.1%) were administered IVIG. Healthcare costs related to HCRU and HCRU rates over 6 months of follow-up will also be reported.Conclusions: In real-world settings,CAR-T administration primarily occurred in the inpatient setting and lasted a mean of 2 weeks, including time in the ICU. During the 30 days post-administration period, some patients required additional acute care services, often due to hematologic toxicity or CRS. A substantial percentage of patients had IVIG pre- or post-administration; however, infections were still observed during the 30 days post administration. These findings inform patient care planning and resource allocation in CAR-T implementation.
Niehoff et al. (Mon,) studied this question.
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