Cost of Post-infusion Monitoring of Patients with LBCL Who Received Lisocabtagene Maraleucel

Chimeric antigen T-cell (CAR-T) therapy administration is usually limited to the inpatient setting due to the frequency of severe adverse events. However, outpatient administration of lisocabtagene maraleucel (liso-cel) may be feasible given the low rates of grade ≥3 adverse events requiring hospitalization, including neurological events and cytokine release syndrome, as demonstrated in clinical studies. Therefore, this study aimed to assess post-infusion monitoring costs and healthcare resource utilization (HCRU) by site of care (inpatient vs outpatient) among patients with relapsed or refractory large B-cell lymphoma (LBCL) treated with liso-cel as second-line therapy in the TRANSFORM study.

Post-infusion monitoring–related HCRU identified from TRANSFORM case reports was assessed using a 2-step methodology to estimate associated costs using a 6-month time horizon beginning on the liso-cel infusion date (excluding drug acquisition costs). Step 1 analyzed HCRU in the 6 months following infusion, including the number of inpatient and intensive care unit days, procedures, diagnostics, and medication use. Unit costs were applied to each HCRU category in step 2, as assessed from the healthcare system perspective, derived from peer-reviewed literature, and adjusted to 2021 US dollars. Patients were outpatient if discharged on the day of infusion or at the end of the observation period.

Of 89 patients treated with liso-cel, 70 (79%) were considered inpatient and 19 (21%) were considered outpatient. Estimated mean 6-month total post-infusion monitoring costs were $95,006 for inpatient and $38,314 for outpatient. Among patients considered outpatient who required subsequent hospitalization (N = 10 [53%]), the mean total length of stay was shorter than for patients treated inpatient (9 vs 14.5 days). Facility costs, especially hospitalizations, were a main contributor to overall mean costs for both inpatient and outpatient liso-cel administration. For inpatient and outpatient administration, 74.9% and 21.5% of median costs, respectively, were incurred within the first month after infusion.

This analysis found estimated mean 6-month post-infusion costs to be 54% lower for outpatient versus inpatient administration of liso-cel. Mean total length of stay was also found to be shorter for hospitalized outpatients versus patients treated as inpatient. Although the number of patients evaluated in the outpatient setting was relatively small, these findings provide further insights into how healthcare systems may optimize financial and material resources for patients with LBCL receiving CAR-T therapy.


McGarvey N, Gitlin M, Lee A, et al. Post-infusion monitoring costs by site of care among patients with relapsed or refractory large B-cell lymphoma who received second-line treatment with lisocabtagene maraleucel in the TRANSFORM study. Presented at: 2022 Academy of Managed Care Pharmacy Nexus Annual Meeting; October 11-14, 2022; National Harbor, MD. Poster C47.

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