(321) Total cost of care (TCOC) and adverse effects (AEs) assessment of bispecific T cell engagers (BiTEs) and Chimeric Antigen Receptor T-Cell (CAR T) therapies for relapsed refractory follicular lymphoma (RRFL)

Background: : Follicular lymphoma (FL) comprises 20–30% of new non-Hodgkin lymphoma cases. FL is hard to cure, with frequent relapses. In the third line RRFL setting, there’s a debate between treatment with BiTE or CAR T. Unlike other hematologic cancers, BiTEs are often preferred over CAR T in RRFL due to their strong, lasting responses, low toxicity, and no need for lymphodepleting chemotherapy. Also, BiTEs offer ease of access due to off-the-shelf availability and lower rates of serious AEs. In a survey of RRFL patients and treating providers, even though progression free survival (PFS) was the key factor for both, decreased AEs ranked above lower PFS. These attributes support BiTEs increased use and potentially lower TCOC. Understanding the real-world TCOC and AE between BiTEs and CART can inform drug management strategies.

Objective: : Compare the 12 month TCOC and AE incidence for patients treated with CAR T versus BiTE therapy in RRFL.

Methods: : Medical and pharmacy claims from 17 million Commercial (COM) and 950k Medicare members were queried to identify members’ first index drug (axicabtagene ciloleucel, tisagenlecleucel, lisocabtagene maraleucel, mosunetuzumab) for RRFL between 12/2021-03/2024. Members requirements included continuous enrollment (CE) 6 months prior to and after their index date and no pre-index BITE/CAR T claims. All members’ claims were used to assess TCOC and post-index AEs (i.e. cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome). AE claims were classified using ICD-10 and/or tocilizumab product-specific codes. Nonparametric and association tests assessed the relationship between index drug and outcomes. No statistically significant differences were found between cohorts (age, sex, rural-urban status, insurance type; α=.05).

Results: : The study consisted of 30 and 31 members in the BiTE and CAR T cohorts, respectively. The mean age was 63 years, 41% were female, 61% had COM coverage and 74% lived in urban areas. The CAR T cohort had significantly (P < 0.05) higher average TCOC ($702k vs $372k), index drug cost ($521k vs $183k), and AE cost ($9k vs <$500) than the BiTE cohort. Index drug costs accounted for 49% and 74% of the total cost of care for the BiTE and CAR T cohorts, respectively. AEs occurred in 23% and 52% of the BiTE and CAR T cohort, respectively. The CAR T cohort was 3.5 times more likely to experience an AE compared to the BiTE cohort (OR=3.5; P=0.03; 95% CI: 0.09-0.86).

Conclusions: : Strong response rates, ease of access, lower drug and total cost, plus reduced AEs make BiTE therapy a feasible alternative to CAR T in RRFL.

Sponsorship:: Prime Therapeutics