The Cost of Innovation: Evaluating the Evolution of Willingness-to-Pay for CAR-T Therapies in Germany

OBJECTIVES: The launch of chimeric antigen receptor (CAR)-T cell therapies has revolutionized treatment for some patients with difficult-to-treat blood cancers. However, these single-dose therapies come at a significant cost to health systems, adding additional complexity to payer decision-making and health budget considerations. This analysis aims to understand trends in launch price and subsequent price erosion for CAR-T therapies in Germany.

METHODS: All CAR-T therapies with European marketing authorization were identified from the EMA database, and product characteristics (indication, orphan status, posology) were collected. Date of first price in Germany, launch price, and price evolution data was extracted from the GlobalData POLI database.

RESULTS: All 6 CAR-T therapies identified are reimbursed in Germany. All therapies, except lisocabtagene maraleucel, have orphan drug designation. Launch cost per dose ranged from €282,000 for brexucabtagene autoleucel (Sep 2022) to €420,000 for ciltacabtagene autoleucel (Feb 2023). Four therapies experienced a post-AMNOG list price reduction after 1 year, with 2 therapies able to maintain price at that point, including the highest priced ciltacabtagene autoleucel (overall mean: -10.5%; mean of products with price change: -15.8%, min, max: 3.9%, 14.1%). Comparing launch list to current list, an average decrease of 18.3% is observed (min, max: 0.0%, 32.3%).

CONCLUSIONS: Despite the first CAR-T therapies launching 6 years ago, in 2018, and with 6 products now available (albeit with different indications), this analysis highlights the continued willingness-to-pay for these innovative therapies in Germany. Indeed, the most recent launch, ciltacabtagene autoleucel, obtained the highest launch price to date, and has thus far maintained this price post-AMNOG. For brexucabtagene autoleucel, with the lowest launch price, parity to the most expensive CAR-T with the same indication was still possible. Overall, understanding evolving payer perceptions and WTP for innovative therapies is critical to inform pipeline planning and ensure continued healthcare innovation.