Sutphin J, Boeri M, Hauber B, Purdum AG. Physician preferences for CAR T therapy: trading off benefits, risks, and time to infusion in the treatment of diffuse large B-cell lymphoma. Poster presented at the 2020 ISPOR Virtual Conference; May 2020. [abstract] Value Health. 2020 May 1; 23(Suppl 1):S19. doi: 10.1016/j.jval.2020.04.094.

OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin’s lymphoma in adults in the United States (US). For patients with relapse/refractory DLBCL, chimeric antigen receptor T-cell therapy (CAR T) is approved after two or more systemic therapy lines. CAR T therapy carries additional risks and requires manufacturing time between leukapheresis (a patient’s T-cells collection) and infusion. Therefore, this study aims to understand physicians’ willingness to trade-off between benefits, risks, and time to infusion.

METHODS: A discrete-choice experiment was administered to US oncologists and hematologists who treated >9 patients with DLBCL in the past year. Respondents were shown two hypothetical patient profiles (one with average and one with rapid disease progression) and for each were asked to make 12 choices between two hypothetical CAR T treatments defined by six attributes: complete response at 6 months, overall survival at 12 and 24 months, time from leukapheresis to infusion, risk of severe cytokine release syndrome, and risk of severe neurological events. Data were analyzed using random-parameters logit.

RESULTS: 150 respondents completed the survey: 79% male, 47% working in academic hospitals, and 63% at hospitals with CAR T available. Because preferences did not vary between patient profiles, data were pooled for the analysis. Decreasing time to infusion from 113 to 16 days yields the highest utility gain (1.91), while shifts from the least- to most-preferred levels of the other attributes yielded lower utility gains (0.51-1.11). Additionally, to reduce time to infusion from 113 to 24 or 16 days, physicians were willing to accept increases in risk >20 percentage points for severe cytokine release syndrome and >22 percentage points for severe neurological events.

CONCLUSIONS: Physicians were willing to accept the risks for the benefits of CAR T; reducing time from leukapheresis to infusion was the most important driver of their choices.

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