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Manage the High Cost of CAR-T in Myeloma
How can myeloma patients manage the high cost of CAR-T cell therapy? I was diagnosed with MM in early 1994. I underwent an ASCT in December of 1995. I relapsed in less than a year. I developed serious long-term side effects from this aggressive, high dose therapy over the next 20 years- side effects that I live with today.
I am telling you all this because, in the article linked below, I focus on a concept to limit financial toxicity-
“One potential approach to help ensure that payers only pay for treatments that provide meaningful clinical benefits is outcome-based payments, which tie the cost of a therapy to its effectiveness, with payments being contingent on the achievement of specific clinical outcomes.”
I offer this idea for two main reasons-
- Cancer patients and their caregivers rarely question the cost of therapy. I didn’t. My ASCT was “experimental” and therefore not covered by my health insurance…
- Drug companies should have no problem charging full price for CAR-T cell therapy for, say, 3 years of complete remission and no damaging side effects during those three years.
I linked the video below because it briefly explains several key concepts about financial toxicity in cancer care.
Financial Toxicity of Cancer Care: Mayo Clinic Radio
I understand that this “proof of efficacy” would be controversial. Consider several additional aspects of my idea.
Regardless of efficacy, the cancer patient pays for the cost to manufacture CAR-T cell therapy ($30-$40,000 according to research)
Upfront agreed upon payment schedule- $30-$40,000 upfront, ______ at one year, _______ at two years, etc. etc.
Anyone who has been diagnosed with MM knows that it is an expensive cancer- under the BEST of circumstances. Financial toxicity will get worse as CAR-T cell therapy becomes more prevalent. I think this idea is one way to help manage the high cost of CAR-T in myeloma.
Email me at David.PeopleBeatingCancer@gmail.com with questions and/or comments about how to manage the high cost of CAR-T in myeloma.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
High Cost of Chimeric Antigen Receptor T-Cells: Challenges and Solutions
Abstract- Chimeric antigen receptor (CAR) T-cells are a cellular immunotherapy with remarkable efficacy in treating multiple hematologic malignancies but they are associated with extremely high prices that are, for many countries, prohibitively expensive. As their use increases both for hematologic malignancies and other indications, and large numbers of new cellular therapies are developed, novel approaches will be needed both to reduce the cost of therapy, and to pay for them. We review the many factors that lead to the high cost of CAR T-cells and offer proposals for reform…’
Payment Models for High-cost Therapies
Even if many of the above approaches combine to reduce the price of CAR T-cells, the cost may still be high, and innovative payment models may be required to meet remaining financial challenges.17,82 These models aim to ensure that patients have access to life-saving treatments while mitigating the financial burden on patients and health care systems.
One potential approach to help ensure that payers only pay for treatments that provide meaningful clinical benefits is outcome-based payments, which tie the cost of a therapy to its effectiveness, with payments being contingent on the achievement of specific clinical outcomes.
For example, a payer may only reimburse the full cost of a CAR T-cell therapy if the patient achieves a predefined treatment response or remains in remission for a certain period of time. As some patients initially respond to CAR T-cell therapy but then rapidly progress, it is important to ensure that the outcome measure being used reflects true clinical effectiveness.83
Although there was some initial enthusiasm for outcome-based pricing approaches in CAR T-cells, especially in Europe,83 current payment approaches in the United States largely do not take outcomes into account.52
It can be difficult for payers and manufacturers to reach agreement regarding the appropriate outcome, time horizon, and adjudication approaches.84Outcome-based pricing models can also be complex and costly for payers and hospitals to administer. Another challenge is how to account for beneficiaries who may change insurance providers or lose their insurance coverage.
CAR T-cell payment models could borrow elements from previous models developed to pay for high-cost therapies. In the mid-2010s, the Louisiana Medicaid program and the Australian health care system pioneered the use of a fixed-fee, subscription model to pay for expensive but curative hepatitis C antivirals.85,86
In this example, the payer pays a fixed price per year for access to the treatment that does not vary with its use. This approach may prove less appealing to manufacturers of cellular therapies with higher manufacturing costs than small molecule drugs, for which the actual amount of drug produced has a much smaller impact on the profit margin. Alternatively, it could lead to a subscription model that is prohibitively expensive…
Conclusion- CAR T-cell therapies have demonstrated remarkable clinical outcomes in certain patients with cancer with otherwise limited treatment options. However, the high costs present a major obstacle for patients, health care providers, and payers.
To ensure a fair price for CAR T-cell therapies and increase access to these potentially life-saving therapies, a multipronged combination of strategies is needed, including
- price negotiation,
- innovative manufacturing approaches,
- and the implementation of alternative payment models.
Addressing these extremely high prices would help to ensure that CAR T-cell therapies are accessible to patients who may benefit from them, without placing an unsustainable burden on health care systems.