Cost and Health Service Utilization Differences between Lymphoma Patients Treated with Commercial CAR-T and Made -in-Alberta Therapies
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".