Healthcare resource use and reimbursement amount by site of care in patients with diffuse large B-cell lymphoma receiving chimeric antigen receptor T-cell (CAR-T) therapy – a retrospective cohort study using CMS 100% Medicare claims database. Issue 2 (28th January 2023)

• Record Type: Journal Article
• Authors: Yang, Hongbo; Bollu, Vamsi; Lim, Stephen; Tesfaye, Mimi; Dalal, Anand A.; Lax, Angela; Sethi, Sakshi; Zhao, Jing
• Is Part Of: Leukemia & lymphoma. Volume 64:Issue 2(2023)
• Page Start: 339
• Page End: 348
• Publication Date: 2023-01-28
• Subjects: Cell and gene therapy -- CAR-T -- tisagenlecleucel -- HRU -- Medicare -- reimbursement; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2022.2147395
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: Chimeric antigen receptor T-cell (CAR-T) infusion settings may impact healthcare resource use (HRU) and reimbursement amounts. Adults with diffuse large B-cell lymphoma receiving CAR-T therapy were identified from the Centers for Medicare & Medicaid Services (CMS) 100% fee-for-service Medicare database and stratified into inpatient (IP; n = 380) and outpatient (OP; n = 50) cohorts based on CAR-T infusion setting. During the first month post-infusion, OP cohort had significantly fewer IP visits, IP days, intensive care unit (ICU) stays, ICU days, and significantly more OP, emergency room (ER) visits, than IP cohort. In subsequent months, HRU became comparable between cohorts. Medicare reimbursement amounts during the first month post-infusion were nominally higher in the OP vs. IP cohort and comparable in subsequent months. The reimbursement amounts did not reflect the reduced HRU with OP infusions, potentially due to differences in Medicare payment policies for OP vs. IP services.