Utilization Trends and Access Disparities in CAR T-Cell Therapy: Real-World Insights From an All-Payer US Healthcare Database (2017-2024)

OBJECTIVES: This study aimed to analyze the utilization trends and access disparities of Chimeric Antigen Receptor T-cell (CAR T) therapy in real-world settings in the United States (US).

METHODS: Using the PINC AI™ Healthcare Database, the largest inpatient and outpatient discharge database in the US, we identified adult patients diagnosed with multiple myeloma, large B-cell lymphoma, lymphoblastic leukemia, follicular lymphoma, and mantle cell lymphoma from January 1, 2017 to March 31, 2024. Patients who received CAR T therapy excluding those enrolled in clinical trials (CAR T group) were compared to all diagnosed patients (overall group) regarding demographics, insurance types, and hospital characteristics for each specific cancer type. Yearly trends of CAR T treatment for each cancer type were also reported.

RESULTS: We identified 1,781 patients who received CAR T therapy. The proportion of patients receiving CAR T therapy for each cancer type increased from 0-0.2% during the year of the product's approval to 0.5-1.3% in 2023. Most CAR T treatments occurred in large (61.9%), urban (99.8%), and teaching hospitals (89.8%). The CAR T group was generally younger, with a mean age range of 38-66 years, compared to 49-70 years in the overall group, and notably fewer aged 75 and above (3-13.7% vs. 12.8-35.6%). There was a higher proportion of males (58.0-83.3% vs. 53.8-70.3%) and fewer Black patients (2.2-19.3% vs. 4.3-21.4%). The prevalence of commercial insurance was higher in the CAR T group compared to the overall group (33.3-46.0% vs. 22.8-39.7%).

CONCLUSIONS: Our findings indicate a steady increase in the use of CAR T-cell therapy, with potential access disparities influenced by age, gender, race, and insurance type. The fact that the majority of treatments occur in large, urban, and teaching hospitals, which host authorized treatment centers, suggests substantial barriers for patients from rural areas or those distant from major healthcare facilities.