Cost and Health Service Utilization Differences between Lymphoma Patients Treated with Commercial CAR-T and Made -in-Alberta Therapies
Notice bibliographique
Résumé
Background A clinical trial using locally manufactured CAR-T cell therapy has been underway in a public health care system in Alberta, Canada, since 2021, which offers shortened time to access therapy, as well as potential economic benefits. The impact of point of care manufacturing on mortality, health service utilization (HSU), and associated costs, as compared to commercial products, is the focus of this study. Methods A difference in difference approach was used to estimate the costs or savings for adult lymphoma patients sequentially enrolled in the Made in Alberta clinical trial (intervention) relative to Kernel propensity score matched standard of care patients who were treated with Yescarta, Kymriah, or Tecartus (control). Specifically, the difference between intervention and control groups in terms of the change in 6-month HSU costs (inpatient, outpatient, physician, and diagnostic imaging services) from pre to post CAR-T infusion date was compared to the difference in list prices between the 2 therapies. Costs for inpatient and outpatient services were based on the case-mix group plus methods, while physician payments were claims paid from the Alberta Health Insurance. Costs for diagnostic imaging services were retrieved from AHS Finance. The price of therapy was based upon list prices or the cost of manufacturing the Made in Alberta CAR-T therapy at local labs. Patients’ demographic (age and sex) and clinical (comorbidity and pre-CAR-T HSU) characteristics were used for estimating propensity scores. Differences in mortality and survival were analyzed using Kaplan-Meier methods and Cox regressions. Results Six-month mortality across the intervention (n=26) and control (n=43) groups was similar (23.1% vs. 25.6%, p>0.05). The multivariate Cox regression showed a hazard ratio of 1.02 (95%CI: 0.31 to 3.34, p>0.05). The savings per patient in 6-month HSU costs were estimated at $3,328 (95%CI:-$69,481 to $62,825, p>0.05). Given the costs were $59,600 for Made in Alberta CAR-T and $485,938 for commercial, the per-patient cost-savings in the intervention group were estimated at $429,666 (95%CI: $363,513 to $495,820). The probability for Made in Alberta CAR-T to be cost-saving was 100%. Conclusion Point of care manufacturing was found to be equivalent with respect to 6-month post mortality and health service utilization, as compared to the standard of care commercial product. At the same time, point of care manufacturing was found to be considerably less costly.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».