Emerging Therapy Solutions ® (ETS) identifies experienced providers for cell therapies to help payers navigate patient access to revolutionary CAR-T treatment options

The arrival of revolutionary chimeric antigen receptor (CAR) T-cell therapies in 2017 has created more options for treating hard-to-treat cancers – with even more indications in the clinical development pipeline and/or pending regulatory approval. Like bone marrow transplants (BMT), which have been a standard of care for many blood cancers since 1968, CAR-T therapies are now becoming a standard of care, and generally as a third-line treatment option for certain forms of aggressive, relapsed and refractory non-Hodgkin lymphoma and leukemias.

Both types of potentially life-changing treatment options carry high risks for patients, and high – sometimes catastrophic – costs for payers. To help payers on behalf of their members better understand and access the treatment options, Emerging Therapy Solutions (ETS) has researched the level of experience of the facilities offering these treatments, offering unparalleled insights to help payers and patients.

“Our customers want their members to access the most effective treatment options, as affordably as possible,” said David J. McLean, Ph.D., co-founder and CEO, ETS. “By identifying the providers most equipped to administer the procedures, and to anticipate and manage the inherently high risks, we can help case managers and payers navigate the options to find the most promising treatment facilities, and plan and price accordingly.”

In current cancer treatment, chemo- and immuno-therapy and bone marrow transplants often precede CAR-T therapy. However, in some cases, depending on the patient’s condition and characteristics, CAR-T therapy might. precede a bone marrow transplant or even eliminate the need for one (depending on how well the CAR – T therapy works).  Attaining continuity of care and access to the right treatment at the right time is critical for achieving the highest quality outcomes, based on the patient’s health care needs. This makes having the patient evaluation directed through an experienced provider a crucial part of their care.

Complex, highly specialized treatments options

CAR-T therapy requires that a patient’s T-cells are collected through a process called apheresis and processed in the laboratory so they will attack cancer cells.  A gene for a special chimeric antigen receptor (CAR) that binds to a certain protein on the patient’s cancer cells is added to the T-cells in the laboratory. Large numbers of the modified CAR-T cells are grown in the laboratory and sent back to the facility for infusion into the patient.   This process usually takes two to three weeks, during which the patient is often at high risk for disease progression and needs continued management by the hematologist or oncologist.

Bone marrow transplant (BMT) is a procedure in which a patient receives healthy stem cells (blood-forming cells) to replace their own stem cells that have been destroyed by treatment with radiation or high doses of chemotherapy. A BMT may be autologous (using a patient’s own stem cells that were collected and saved before treatment), allogeneic (using stem cells from a related or unrelated donor), or syngeneic (using stem cells donated by an identical twin).

The two treatment options require similarly rigorous clinical resources, infrastructures and expertise.

Why experience matters

Programs that excel at bone marrow transplants tend to have the resources, infrastructure and experience to deliver care in a more cost-effective manner. They are better able to manage the potential serious complications and severe side effects of treatment, which may require ICU care or hospital admission post-administration. As more CAR-T therapies come to market and those already approved gain expanded indications, this differentiation will become even more important.

“A center that has strong experience in both CAR-T and BMT will be in the best position to make an evaluation and prescribe the best option for that individual, based on the patient’s specific condition characteristics and situation,” McLean said. In addition, these centers have access to clinical trials that may provide a CAR-T therapy option that even improves on the current expected outcomes of the FDA-approved therapies.

To identify providers that have amassed the most experience with both therapies, ETS developed and released a CAR-T request for information in July 2020 to all ETS network facilities that offer commercial CAR-T therapy. ETS then evaluated the collected information along with bone marrow transplant volume and outcomes data from the American Society for Transplantation and Cellular Therapy. The objective was to determine through analysis which providers have the most experience with both CAR-T therapy and bone marrow transplants.

Using benchmark criteria, including the number of bone marrow transplants performed in the previous year for adults (autologous and allogeneic), as well as CAR-T experience, and participation in CAR-T clinical trials, ETS identified the treatment centers with the most experience in both CAR-T and bone marrow transplant.

Referrals for health plans

As a result, ETS began to classify which providers currently offer the deepest expertise – and therefore most likely have the most cost-effective, streamlined resources – to effectively evaluate, prescribe, treat and manage the therapies.

In addition, as more data is generated on CAR-T therapy clinical and economic outcomes, ETS plans to use the information to create a list of providers to help payers match plans to the most appropriate facilities.

Currently, ETS is not making the findings public, but is sharing gained perspectives with customers for referrals. To learn more, please contact us.

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