Non-drug expenses may be particularly burdensome to patients receiving chimeric antigen receptor (CAR)-T cell immunotherapy for cancer, according to a research letter published in JAMA Oncology.1

While tisagenlecleucel and axicabtagene ciloleucel, 2 CAR-T immunotherapies that received US Food and Drug Administration (FDA) approval last year, are priced at $475,000 and $373,000, respectively, these costs do not include non-drug costs due to adverse events, leukapheresis, and lymphodepletion therapy. More than 40% of patients who receive CAR-T therapy may, for example, require intensive care for cytokine release syndrome (CRS).

For this study, the total costs, inclusive of non-drug costs, for CAR-T therapy were estimated using available data. To determine average (mean) cost, the authors “added up the expected costs of the drug product in each scenario and its expected probability and then divided the sum by the probability of being treated.”

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The total costs of tisagenlecleucel treatment ranged from $478,777 to $531,823, depending on presence and severity of CRS. The mean expected costs of tisagenlecleucel and axicabtagene ciloleucel were $510,963 and $402,647, respectively, though outcomes-based reimbursement may reduce the cost of tisagenlecleucel to $432,131.

Taken together, the number of patients eligible for either drug would correspond to annual expenditures in excess of $3.2 billion.

The authors noted, furthermore, that while non-drug costs account for only 7% of CAR-T therapy–related expenses, these costs may range from $30,000 to $56,000. They concluded that as more patients begin to receive these therapies, “accurately measuring and accounting for the associated nondrug costs will be important when assessing the treatment’s true costs and value and when negotiating pricing arrangements.”


  1. Hernandez I, Prasad V, Gellad WF. Total costs of chimeric antigen receptor T-Cell immunotherapy. JAMA Oncol. 2018 Apr 26. doi: 10.1001/jamaoncol.2018.0977 [Epub ahead of print]