5 September 2019
Using the tools of biotechnology and immunology to help transforming cancer from a fatal to a manageable — or even curable – disease holds profound benefits to individual patients and the wider society.
Patients have an increased quality of life, returning to their family, community and potentially their work force. Society saves healthcare costs and manufacturers thrive, enhancing economic wellbeing.
Now, writing in the American Journal of Managed Care, https://www.ajmc.com/journals/issue/2019/2019-vol25-n8/the-potential-impact-of-car-tcell-treatment-delays-on-society, Julia Thornton Snider and colleagues have calculated the “social value” of lifesaving CAR-T-cell therapy for patients with two conditions: paediatric acute lymphoblastic leukaemia (ALL) and diffuse large B-cell lymphoma (DLBCL) where complete and partial recovery is initially very high (~90%) and long term. That is, when 62% of ALL patients remain cancer free (2 years) and 43% of DLBCL patients remain cancer free (1.5 years).
They found US$6.5 billion and US$34.8 billion in social value were generated in ALL and DLBCL, respectively. Conversely, the percentage loss in the social value of delaying treatment of these patients were 10%, 36%, and 67% of the social value for ALL and 4%, 11% and 46% for DLBCL. The percentage loss occurred when treatment was delayed 1 month, 2 months and 6 months, respectively. Any delay in treating patients has a profound impact on them and on the social value to the whole community.
In the US, delays in receiving CAR-T treatment pivot on the time taken to arrange reimbursement for the expensive therapy, as well as manufacturing delays in producing sufficient CAR-T-cells for sick patients. Delays of 90 days or longer have been experienced. Considerable delay in beginning treatment or generating CART-cells is not uncommon.
In Australia, delays in treatment will also be very common, but the social value parameter will be different to the US. Since social value is the sum of consumer surplus and manufacture profit, the latter doesn’t accumulate for the Australian community because, presently, the profits arise for overseas companies who develop these CAR-T therapies.
Consumer surplus is the value of the health gain, less the incremental cost to the patient. This will be substantial if treatment is available at very reduced cost through the Australian pharmaceutical benefits scheme.
The very relevant points made by Snider and colleagues underline the need for Australian companies to develop new effective CAR-T therapies for cancer and infection and to ensure that CAR-T therapy is available without delay for patients. Presently there are few Australian CAR-T companies developing innovative new therapies and few Australian hospitals capable of generating autologous CAR-T product for autologous therapies.
The development of “off-the-shelf” allogeneic immunotherapies is important for social value as it will both reduce cost and increase manufacturing profits if developed in Australia. Once available, such therapies will virtually eliminate the need for personalised treatments to extract the therapeutic product for each patient.
It’s imperative that Federal and State Governments respond promptly and adequately to ensure Australians benefit from the potential social value of CAR-T therapy. Researchers and Australian companies need financial support to be competitive in delivery of the manufacturing profits that add to the social value for Australia.
Without enhanced policy and funding support, delays will be substantial for Australian patients and curative medicine and social value will be badly eroded.