CAR T-Cell Therapy Cost Effectiveness

Chimeric Antigen Receptor (CAR) T cell therapy is an immunotherapy that uses genetically modified T cells to target and kill cancer cells. The treatment has shown promising results in clinical trials for various types of cancer, including large B cell lymphoma (58% success rate) and multiple myeloma (60% accordingly).

The estimated cost of CAR T-cell treatment starts from $55,000 to $450,000 per infusion. The total prices vary by country:

• USA from $370,000;
• UK from $130,000;
• China from $55,000;
• Israel from $100,000;
• Spain from $430,000;
• Turkey from $55,000.

This article will explore what drives the T-cell therapy price, how costs vary worldwide, and how CAR T-cell therapy differs from other cancer treatments.

Table of Contents

• What Types of Cancers Qualify for T-Cell Therapy?
• What Are the Eligibility Criteria?
• What's the Difference Between In-House and Commercial CARs?
• How Does CAR T Cell Therapy Work
• What Are the Side Effects Associated With CAR T Cells?
• What Factors Influence the CAR T Price?
• Where to Get CAR T-Cell Treatment
• How Much Does CAR T Cost in Europe?
• The Cost of CAR T-Cell Therapy for Children
• Comparing Costs with Traditional Cancer Treatments
• Indirect Costs Associated with CAR T-Cell Therapy
• Why Is CAR T-Cell Therapy So Expensive?
• Does Insurance Cover CAR T-Cell Therapy?
• The Value of CAR T-Cell Therapy
• Efficacy of Clinical Trials
• How to Request Help at Bookimed

What Types of Cancers Qualify for T-Cell Therapy?

CAR T-cell therapy is primarily approved for the treatment of certain blood cancers, including:

• Acute lymphoblastic leukemia (ALL);
• Diffuse large B-cell lymphoma (DLBCL);
• Primary mediastinal large B cell lymphoma (PMBCL);
• Mantle cell lymphoma;
• Multiple myeloma.

CAR T-cells can stay in the body for months or even years after treatment, but this varies between patients. Over time, their numbers may decrease. The researchers also look for T cells potential to improving outcomes of sarcomas and other solid tumors.

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What Are the Eligibility Criteria?

There are several points to consider before administering CAR T-cell therapy:

• Age. Some CAR T-cell therapies are approved for patients up to 25, while others may have different age restrictions.
• Stage of cancer. The cancer must be at an advanced stage and have not responded to other treatments.
• Overall health. The patient must be in good general health and able to tolerate the treatment. They must not test positive for uncontrolled infection, such as HIV or active hepatitis C.
• Comorbidities. Patients with any heart disease or diabetes may still be eligible. However, these conditions require close monitoring during the treatment process.

Is CAR T-Cell Therapy Possible After Autologous Stem Cell Transplantation?

People with a type of leukemia called precursor B-ALL who relapse after autologous stem cell transplantation have a very bad outlook.

The clinical trials show that patients with B-ALL who get sick again, have a better chance of staying well if the relapse occurs more than 6 months later (complete responses rate 55.5% compared to 18.4%).

It doesn't matter whether the patient had a previous HSCT. The probability of remission is not different for patients with or without autologous stem cell transplantation. The two-year survival rate is 45.3% for both cases.

What's the Difference Between In-House and Commercial CARs?

Most patients feel suspicious about the lower costs of CAR T-cell therapies. They think it's because of poor doctors' expertise in less-quality gene materials. However, the underlying reason can be much more straightforward.

The advanced medical centers have labs that can grow the modified T-cells more quickly. The other hospitals and clinics ship the cells abroad by freezing them. This makes the price higher due to the more complex manufacturing process.

Below you will find the main differences between the so-called "in-house" and commercial CAR T-cell therapies:

So far, commercial CAR T-cell therapy is approved for a limited number of illnesses. The table below provides an overview and the cost breakdown of the most popular CAR T drugs.

Researchers are still exploring the potential of CAR T-cell therapy for treating a more comprehensive range of cancers, including solid tumors.

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How Does CAR T Cell Therapy Work

The relationship between antigens and immune receptors is like a lock and key. Only the correct immune receptor, like a specific key, can fit and bind to a particular foreign antigen, just as a key fits into a matching lock.

The CAR T cell therapy process involves several key steps:

• Identify treatment strategy. The doctors should decide if CAR T-cell therapy will work on this patient.
• Large central line placement. It is an operative procedure where the doctor places a large-bore IV in a big vein to collect the T cells.
• Apheresis. The doctors keep the prescribed dose of T cells and return the rest into the bloodstream.
• Genetic modification. The immune cells undergo a genetic modification to express a chimeric antigen receptor (CAR).
• Expansion. It takes time to grow millions of modified T cells so that they can fight cancer effectively.
• Chemotherapy conditioning. The patients should undergo chemotherapy for up to 5 days to clear out the maximum of cancer cells.
• CAR T-cell therapy. The T cells are reintroduced into the patient's bloodstream.
• Observation. The patient stays in the intensive care unit to ensure there won't be any side effects (including the most common - cytokine release syndrome).

What Are the Side Effects Associated With CAR T Cells?

While highly effective against certain challenging cancers (like large B-cell lymphoma), CAR T-cell therapy can also lead to severe or potentially life-threatening side effects. Therefore, it must be administered in a specialized medical center and requires rigorous monitoring for at least 2 weeks post-treatment.

Cytokine Release Syndrome

Cytokine release syndrome (CRS) is the most common side effect of CAR T-cell therapy. It happens in about 37% to 93% of patients. CRS usually starts within a few days after the treatment but can also start up to 14 days later.

CRS occurs when the immune system becomes overactivated in response to the CAR T cells, releasing large amounts of cytokine signaling molecules. This syndrome can be managed with supportive care and medications, but it can be life-threatening if not treated promptly.

The main symptom of CRS is fever ≥ 38.0 °C or higher. Other symptoms include

• Muscle aches;
• Tiredness;
• Low blood pressure;
• Trouble breathing;
• Stomach issues;
• Fast heartbeat;
• Rash.

Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS)

Another side effect of CAR T-cell therapy is called ICANS. It happens in about 40% of patients. ICANS usually starts after CRS and sometimes even after CRS goes away. ICANS often show up within 4 to 10 days after the treatment.

One of the main ICANS mechanisms is damaging the blood-brain barrier, which causes swelling and subsequent abnormal behavior.

The main symptoms are:

• Trouble finding words;
• Complicated small movements;
• Limb weakness;
• Memory loss;
• Confusion or agitation;
• Tremors.

Other Issues

The remaining symptoms are not specified and depend solely on the patient's condition. They might have an allergic reaction to the medical components or be predisposed to infections due to a weaker immune system.

What Factors Influence the CAR T Price?

Here's an overview of the most common factors affecting T-cell therapy cost:

• Country. Due to government regulations and manufacturing processes, China and Turkey offer twice as low expenses as Israel and the UK. The cost is also different for hospitals that ship T cells for modification and those performing the gene mutation on-site.
• Type of CAR T-cell therapy. The average price for CAR T-cell medications is $400,000. Kymriah, the first ever CAR T-cell product, costs around $373,000 per procedure, while Carvykti, approved in 2022, will cost $465,000.
• Specific cancer type. The type of cancer being treated can influence the cost. The most common conditions include advanced/resistant lymphoma and acute lymphoblastic leukemia.
• Treatment center. The cost of CAR T-cell therapy can be influenced by the chosen medical center's pricing policies and location.

Where to Get CAR T-Cell Treatment

The leading hospitals to undergo CAR T-cell treatment are located in:

China

Chinese doctors have developed a new version of T-cell therapy, which costs less than the original one. The high patient demand and government support have contributed to researchers seeking more affordable treatment options. The average cost of CAR T-cell therapy in China is $210,000.

Turkey

Turkey has become a popular destination for CAR T-cell therapy, attracting thousands of patients worldwide each year. Finding highly qualified medical professionals proficient in English specializing in CAR T-cell therapy is easy. The average cost of CAR T-cell therapy in Turkey is $55,000.

Israel

Israeli clinics also offer advanced immunotherapy methods at 30-80% lower prices than in the U.S. This happens because the T-cells are grown on-site instead of shipping from abroad.Israel is the homeland of CAR T-cell therapy. Prof. Zelig Eshhar from the Weizmann Institute grew the modified T cells in 1989. Sheba Medical Center is one of the most prominent hospitals offering CAR T-cell therapy to cancer patients. The average cost of CAR T-cell therapy in Israel is $300,000.

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Prof. Arnon Nagler, the President of Sheba’s Hemato-Oncology Center, has treated over 17 patients with CAR T-cell therapy in recent years. Of these patients, 75% achieved complete remission. 

Named one of Israel’s leading hematologists, the professor advocates for producing T-cells in-house rather than relying on commercial sources. He believes that using engineered T-cells from abroad significantly increases the cost of the procedure and makes it less accessible.

“Managing the entire process onsite allows for a substantially shorter vein-to-vein time, reducing the process to about 10 days, which spares the patient the necessity of bridging therapy.” - Prof. Arnon Nagler, the oncologist with over 40 years of experience in immunotherapy approaches. 

 

How Much Does CAR T Cost in Europe?

In Europe, Kymriah and Yescarta are two widely used CAR T-cell therapies targeting specific blood cancers. In countries like Germany, France, and the United Kingdom, CAR T-cell therapy can cost between €300,000 and €350,000 per treatment.

Here's a breakdown of approximate CAR T-cell therapy costs in some European countries:

The costs may vary depending on the center's policy, exchange rates, and individual treatment strategy. Contact the Bookimed coordinator to get the estimated calculation of your specific case.

Additional factors influencing costs are:

• Travel and accommodation, including flight, lodging, and living expenses.
• Insurance coverage. Some insurance providers may have restrictions or exclusions for CAR T-cell therapy coverage.

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The Cost of CAR T-Cell Therapy for Children

One of the most common child malignancies is B-cell precursor acute lymphoblastic leukemia (B-ALL). It affects nearly 79% of kids from 2 to 6 years old, among the other pediatric leukemias. B-ALL is a type of blood cancer where too many immature white blood cells called B-cell lymphoblasts grow too quickly in the bone marrow and blood.

(fact) A study of 37 children with B-ALL who received CAR-T therapy in the US found that the average cost was $620,500 for 90 days. Most of the cost was for hospital stays. The prices in European clinics are much lower (from $120,000 in Israel to $450,000 in Spain), even accounting for the additional expenses.

There are no significant differences in CAR T cancer treatment cost based on age or whether the child had CRS. While CAR T-cells offer remarkable clinical benefits for large B-cell lymphoma and other cancers, their high price can limit access for many patients.

The cost would likely be similar to adult patients, but only medical facilities can provide the estimated price. However, the high value of CAR T-cell therapy can be a significant financial burden for families with children who need this treatment. 

Contact Bookimed to get a personalized treatment strategy and hospital recommendations.

Comparing Costs with Traditional Cancer Treatments

The difference in cost can be significant when comparing CAR T-cell therapy to traditional cancer treatments like chemotherapy or radiation. CAR T-cell therapy tends to be more expensive due to its advanced, personalized approach that involves modifying a patient's immune cells. 

Below is a breakdown of prices for CAR T-cell therapy compared to other popular treatments in European countries.

Method of Treatment	CAR T-cell therapy	Chemotherapy	Radiation therapy	Targeted therapy
Turkey	From $55,000	From $20,000	From $15,000	From $10,000
Israel	From $100,000	From $40,000	From $14,000	From $9,000
Spain	From $170,000	From $20,000	From $15,000	From $7,000

Despite the higher upfront cost of CAR T-cell therapy, many patients opt for it because of its potential to target cancer more effectively, particularly in cases where traditional treatments have not worked. 

Indirect Costs Associated with CAR T-Cell Therapy

CAR T-cell therapy is expensive, but there are additional costs to consider. The indirect costs can significantly impact the overall cost of treatment and become a financial burden for patients and their families. 

Travel and Accommodation Expenses

The expenses associated with transportation, lodging, and meals can be substantial for patients who need to travel abroad to specialized treatment centers. The average cost per patient is approximately $5368 for flights and accommodation.

This is particularly relevant for those seeking treatment in countries with advanced CAR T-cell therapy programs, such as the United States, Israel, or Turkey.

Post-Treatment Monitoring and Care

CAR T-cell therapy often requires extensive follow-up care to monitor potential side effects and assess treatment response. This can involve:

• ✅ Regular doctor's appointments;
• ✅ Laboratory tests;
• ✅ Imaging studies;
• ✅ Emergency situations (such as on-site CRS management).

Patients and their caregivers may also need to take time off work, which can lead to financial problems. Since CAR T-cell therapy presumes a hospital stay, it may compromise a full-time occupation.

Why Is CAR T-Cell Therapy So Expensive?

The main reasons include:

• Research and development. It takes a lot of time and money to develop specific T cells.
• Complex manufacturing process. It's a personalized treatment, so it's made specifically for each patient. This makes it more complex and expensive to produce.
• Need of special equipment. The CAR T-cell therapies require advanced equipment and skilled workers.
• Regulatory compliance. It must meet strict safety standards, which adds to the cost.
• Limited eligibility. Because CAR T-cell therapy is only approved for a few types of cancer and is usually used when other treatments don't work, there aren't many patients who can get it.

The cost of CAR T therapy reflects its personalized nature and expensive clinical trials. Thus, the cost is high due to the special conditions required to manufacture T cells.

How to Reduce CAR T-Cell Therapy Costs

To address the high cost of CAR T-cell therapy, several potential solutions can be explored:

• Government Support. Governments can provide subsidies or negotiate lower prices with pharmaceutical companies to make treatment more accessible.
• Global Partnerships. Collaborating with countries with lower healthcare costs can offer patients more affordable options.
• Local Production. Hospitals can expand their production capabilities to reduce shipping and processing expenses.

By implementing these strategies, it may be possible to make CAR T-cell therapy more affordable for patients and reduce the financial burden associated with this life-saving treatment.

Does Insurance Cover CAR T-Cell Therapy?

Given the high cost of CAR T-cell therapy, financial assistance, and funding options are crucial for many large B-cell lymphoma patients. Fortunately, several avenues can help alleviate the financial burden.

• Many insurance companies cover CAR T-cell therapy, but the extent of coverage can vary widely depending on the specific policy and the patient's condition. Plus, the patients should discuss any potential out-of-pocket costs with their insurance provider.
• Pharmaceutical companies also offer patient assistance programs to help patients access CAR T-cell therapy. These programs can provide financial support, including covering some or all of the treatment costs for eligible patients.
• Government programs such as Medicare and Medicaid in the USA may cover CAR T-cell therapy for eligible patients, providing another layer of financial support.

Many options are available to help patients with the cost of CAR T-cell therapy for patients with large B-cell lymphoma or follicular lymphoma. Exploring these options is essential to find the best solution for every situation.

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The Value of CAR T-Cell Therapy

CAR T-cell therapy is a complex and expensive treatment that can cost over $400,000. This has led to debate about whether it's worth the cost.

Some studies suggest that CAR T-cell therapy can be cost-effective in some instances, especially when it helps patients live longer and have a better quality of life. However, the current prices are too high for many people.

Researchers are working to find ways to make CAR T-cell therapy more cost-effective. Ultimately, the cost-effectiveness will depend on the type of cancer, the patient's health, and available financial assistance.

Efficacy of Clinical Trials

CAR T-cell therapy has been shown to work well in many clinical trials, especially for patients with cancer that don't respond to other treatments. These trials have demonstrated that CAR T-cell therapy can help people live longer and stay in remission.

Researchers are actively working to enhance the safety and efficacy of CAR T-cell therapy. This includes developing new CAR designs that can more precisely target cancer cells while minimizing off-target effects. Additionally, combination therapies that pair CAR T-cell therapy with other treatments are being investigated to improve outcomes further.

Despite the challenges, CAR T-cell therapy offers hope for patients with previously difficult-to-treat cancers. As clinical trials continue to advance, patients can expect to see even greater improvements in the safety and accessibility of this therapeutic approach.

How to Request Help at Bookimed

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💚Submit a Request. Share your medical details and treatment goals using our simple form.

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