Introduction

We previously examined how expanding access to chimeric antigen receptor (CAR) T cell therapy administration sites impacted patient travel distances and time. In the current study, we estimated travel-related economic burden associated with site-of-care options among patients with relapsed/refractory diffuse large B cell lymphoma.

Methods

We used geographic information system methods to quantify travel-related economic burden across three site-of-care scenarios: academic hospitals; academic and community multispecialty hospitals; and academic and community multispecialty hospitals plus nonacademic specialty oncology network centers. Socioeconomic status, administration sites, and county of residence were derived from the US Census Bureau and publicly available sources. Travel costs were based on governmental guidelines, US census wage data, and Bureau of Transportation Statistics. Travel distance and time to the nearest CAR T cell therapy administration sites were estimated from previous research.

Results

Total national estimated costs associated with traveling for CAR T cell therapy were $21.1 million if CAR T cell therapy was offered exclusively in academic hospitals, and $14.7 million if expanded to include community hospitals plus nonacademic specialty oncology network centers, representing a $6.5-million reduction associated with expanding access to eligible patients. The largest cost-saving component was lodging/meals. Regional and demographic cost differences were statistically significant between academic hospitals and nonacademic hospitals/specialty oncology centers. In all scenarios, patients living below the federal poverty level (FPL) had higher weighted mean total costs versus patients living above the FPL. White and Native American patients were estimated to have the highest weighted mean total costs across race/ethnicity groups. For all subgroups, costs were reduced by expanding access beyond academic hospitals.

Conclusion

CAR T cell therapy is currently restricted to academic hospitals; total travel costs could be substantially decreased if access is expanded to nonacademic hospitals and specialty oncology centers. Patients in rural areas and those living below the FPL are particularly disadvantaged by restricted access.

中文翻译：

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按护理部位进行嵌合抗原受体 T 细胞治疗的旅行相关经济负担

介绍

我们之前研究了扩大对嵌合抗原受体 (CAR) T 细胞治疗给药部位的访问如何影响患者的旅行距离和时间。在当前的研究中，我们估计了与复发/难治性弥漫性大 B 细胞淋巴瘤患者的医疗地点选择相关的旅行相关经济负担。

方法

我们使用地理信息系统方法来量化三个护理场所场景中与旅行相关的经济负担：学术医院；学术和社区多专科医院；学术和社区多专科医院以及非学术专科肿瘤学网络中心。社会经济地位、行政地点和居住县来自美国人口普查局和公开来源。差旅费用基于政府指导方针、美国人口普查工资数据和交通统计局。到最近的 CAR T 细胞治疗给药部位的旅行距离和时间是根据之前的研究估计的。

结果

如果仅在学术医院提供 CAR T 细胞治疗，全国估计与 CAR T 细胞治疗相关的总费用为 2110 万美元，如果扩展到包括社区医院和非学术专科肿瘤学网络中心，则为 1470 万美元，相当于减少了 650 万美元扩大对符合条件的患者的访问。最大的节省成本的部分是住宿/膳食。学术医院和非学术医院/专科肿瘤中心之间的区域和人口成本差异具有统计学意义。在所有情况下，与生活在联邦贫困线以上的患者相比，生活在联邦贫困线以下的患者的加权平均总成本更高。据估计，白人和美洲原住民患者在种族/族裔群体中的加权平均总成本最高。

结论

CAR T细胞疗法目前仅限于学术医院；如果扩大到非学术医院和专科肿瘤中心，总旅行费用可能会大大降低。农村地区的患者和生活在 FPL 之下的患者尤其因进入受限而处于不利地位。