The cost to treat cancer in the United States could reach $156 billion in 2020, according to the National Cancer Institute. And innovative medications have a significant impact on the cost of care.
To illustrate the growth of new therapies, Jacob Chaffee, PharmD, clinical pharmacist for emerging therapies at Blue Cross Blue Shield of Michigan, noted during his presentation at the Academy of Managed Care Pharmacy Managed Care and Specialty Pharmacy (AMCP) Annual Meeting, in Boston April 25, that more than 45 novel cancer therapies have been approved by the FDA since 2013. And more than 600 molecules are in a late-stage pipeline.
According to Chaffee, two milestones for novel cancer treatment include FDA’s approval in August 2017 of the first CAR-T therapy, Kymriah (tisagenlecleucel), for certain pediatric and young adult patients with a form of acute lymphoblastic leukemia. In October 2017, the federal agency approved a second CAR-T therapy, Yescarta (axicabtagene ciloleucel), for the treatment of adult patients with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment.
Chaffee defined some of the terms used in novel cancer treatment, including:
• CAR-T therapy, where a patient’s immune cells are reengineered, and returned to their body. The cells, in turn, expand and serve as “living drugs” to recognize and target tumor cells. These cells can remain within the patient’s body for months after the infusion, which can lead to long-term remission.
• CRISPR, which is also referred to as CRISPR-Cas9, targets specific stretches of DNA for editing using programmable systems. In this process, genes in living cells can be modified or corrected in the treatment of genetic causes of disease or to improve current therapies to treat cancer, muscular dystrophy, and HIV and other infectious diseases. (According to the International Society for Stem Cell Research, using CRISPR/Cas9 together with CAR-T therapy may improve the engineering of T cells where they carry multiple therapeutic features for either increasing specificity or suppressing side effects, or both. Further, the risk of inserting the CAR gene in inappropriate locations can be reduced through the use of CRISPR/Cas9.)
Payers’ primary concerns with CAR-T therapy
Chaffee noted that payers are particularly concerned with the following when it comes to CAR-T therapy:
- Efficacy and outcomes
- Safety profile
He then broke down the total cost of care associated with CAR T, which can range from $523,000 to $795,000 per case. The breakdown of those costs includes:
- Drug cost, which can range from $373,000 to $475,000
- Administration and monitoring, which can range from $50,000 to $120,000
- Adverse events, which can range from $100,000 to $200,000
To illustrate a possible model for payment of treatments such as CAR T, Chaffee's colleague, Christina Link, PharmD, a clinical manager for the payer’s specialty pharmacy utilization management team, then shared the following results of moving the site of care to community oncology centers when providing patients with novel cancer treatments:
- $8,000 decrease in medical costs per patient per month
- Fewer emergency department encounters
- 18% reduction in emergency department visits at 10 days
- 28% reduction in emergency department visits in 72 hours
- Decreased physician visits