Advancing Equity in CAR T-Cell Therapy: An Analysis of Health Technology Assessments by Canada's Drug Agency and the National Institute for Health and Care Excellence
Author(s)
Lydia Vinals, PhD1, Amruta Radhakrishnan, MPH2, Grammati Sarri, MSc, PhD3.
1Cytel, Montreal, QC, Canada, 2Cytel, Mississauga, ON, Canada, 3Cytel, London, United Kingdom.
1Cytel, Montreal, QC, Canada, 2Cytel, Mississauga, ON, Canada, 3Cytel, London, United Kingdom.
OBJECTIVES: Chimeric antigen receptor T-cell (CAR T-cell) therapies have revolutionized treatment for hematological malignancies. Access disparities related to cost, delivery complexity, and manufacturing challenges limit equitable benefits, especially among minority and vulnerable populations impacted by social determinants tied to diversity, equity, and inclusion (DEI). This review examines if and how health technology assessments (HTAs) by Canada’s Drug Agency (CDA) and the National Institute for Health and Care Excellence (NICE) consider equity in evaluating CAR T-cell therapies.
METHODS: HTA reports from CDA and NICE for six CAR T-cell therapies (Abecma, Breyanzi, Carvykti, Kymriah, Tecartus, Yescarta) were reviewed by two researchers for equity considerations related to access disparities, capacity, socioeconomic determinants, and related clinical and economic evidence. A pre-specified template guided data extraction. Results were summarized thematically.
RESULTS: Eighteen CDA and NICE submissions published between 2021 and 2024 were reviewed. Excluding five terminated submissions, 13 HTAs (CDA=7; NICE=6) across five indications were included. All CDA submissions highlighted disparities in disease incidence, treatment, and outcomes by race, socioeconomic status, diagnosis and referral patterns, and age, noting financial and geographical barriers disproportionately affecting marginalized groups. Six CDA submissions criticized economic evaluations for underestimating indirect travel and caregiver costs, with three highlighting unrepresentative trial populations. The CDA appraisal of Abecma included a scenario analysis with indirect costs (parking, caregiving, and productivity loss). In five submissions, NICE critiqued the additional indirect costs submitted by companies. NICE Committees in two appraisals raised concerns about the lack of evidence for older and transplant-ineligible patients.
CONCLUSIONS: This review identified that DEI considerations related to CAR T-cell therapy access like patient costs and geographical barriers were not routinely supported by evidence in CDA and NICE submissions. Evidence generation challenges in CAR-T therapy may inadvertently deprioritize equity concerns. Recent commitments to equity from HTA bodies offer opportunities to ensure fair access to novel, high-cost therapies.
METHODS: HTA reports from CDA and NICE for six CAR T-cell therapies (Abecma, Breyanzi, Carvykti, Kymriah, Tecartus, Yescarta) were reviewed by two researchers for equity considerations related to access disparities, capacity, socioeconomic determinants, and related clinical and economic evidence. A pre-specified template guided data extraction. Results were summarized thematically.
RESULTS: Eighteen CDA and NICE submissions published between 2021 and 2024 were reviewed. Excluding five terminated submissions, 13 HTAs (CDA=7; NICE=6) across five indications were included. All CDA submissions highlighted disparities in disease incidence, treatment, and outcomes by race, socioeconomic status, diagnosis and referral patterns, and age, noting financial and geographical barriers disproportionately affecting marginalized groups. Six CDA submissions criticized economic evaluations for underestimating indirect travel and caregiver costs, with three highlighting unrepresentative trial populations. The CDA appraisal of Abecma included a scenario analysis with indirect costs (parking, caregiving, and productivity loss). In five submissions, NICE critiqued the additional indirect costs submitted by companies. NICE Committees in two appraisals raised concerns about the lack of evidence for older and transplant-ineligible patients.
CONCLUSIONS: This review identified that DEI considerations related to CAR T-cell therapy access like patient costs and geographical barriers were not routinely supported by evidence in CDA and NICE submissions. Evidence generation challenges in CAR-T therapy may inadvertently deprioritize equity concerns. Recent commitments to equity from HTA bodies offer opportunities to ensure fair access to novel, high-cost therapies.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P19
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Rare & Orphan Diseases