Real-world experience of CAR T-cell therapy in older patients with relapsed/refractory diffuse large B-cell lymphoma.

The emergence of chimeric antigen receptor (CAR) T-cell therapy has changed the treatment landscape for diffuse large B-cell lymphoma (DLBCL); however, real-world experience reporting outcomes among older patients treated with CAR T-cell therapy is limited. We leveraged the 100% Medicare fee-for-service claims database and analyzed outcomes and cost associated with CAR T-cell therapy in 551 older patients (aged ≥65 years) with DLBCL who received CAR T-cell therapy between 2018 and 2020. CAR T-cell therapy was used in third line and beyond in 19% of patients aged 65 to 69 years and 22% among those aged 70 to 74 years, compared with 13% of patients aged ≥75 years. Most patients received CAR T-cell therapy in an inpatient setting (83%), with an average length of stay of 21 days. The median event-free survival (EFS) following CAR T-cell therapy was 7.2 months. Patients aged ≥75 years had significantly shorter EFS compared with patients aged 65 to 69 and 70 to 74 years, with 12-month EFS estimates of 34%, 43%, and 52%, respectively (P = .002). The median overall survival was 17.1 months, and there was no significant difference by age groups. The median total health care cost during the 90-day follow-up was $352 572 and was similar across all age groups. CAR T-cell therapy was associated with favorable effectiveness, but the CAR T-cell therapy use in older patients was low, especially in patients aged ≥75 years, and this age group had a lower rate of EFS, which illustrates the unmet need for more accessible, effective, and tolerable therapy in older patients, especially those aged ≥75 years.

Impact of home-based, patient-centered support for people with advanced illness in an open health system: A retrospective claims analysis of health expenditures, utilization, and quality of care at end of life.

BACKGROUND: Home-based care coordination and support programs for people with advanced illness work alongside usual care to promote personal care goals, which usually include a preference for home-based end-of-life care. More research is needed to confirm the efficacy of these programs, especially when disseminated on a large scale. Advanced Illness Management is one such program, implemented within a large open health system in northern California, USA. AIM: To evaluate the impact of Advanced Illness Management on end-of-life resource utilization, cost of care, and care quality, as indicators of program success in supporting patient care goals. DESIGN: A retrospective-matched observational study analyzing medical claims in the final 3 months of life. SETTING/PARTICIPANTS: Medicare fee-for-service 2010-2014 decedents in northern California, USA. RESULTS: Final month total expenditures for Advanced Illness Management enrollees ( N = 1352) were reduced by US$4824 (US$3379, US$6268) and inpatient payments by US$6127 (US$4874, US$7682). Enrollees also experienced 150 fewer hospitalizations/1000 (101, 198) and 1361 fewer hospital days/1000 (998, 1725). The percentage of hospice enrollees increased by 17.9 percentage points (14.7, 21.0), hospital deaths decreased by 8.2 percentage points (5.5, 10.8), and intensive care unit deaths decreased by 7.1 percentage points (5.2, 8.9). End-of-life chemotherapy use and non-inpatient expenditures in months 2 and 3 prior to death did not differ significantly from the control group. CONCLUSION: Advanced Illness Management has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death. This suggests that home-based support programs for people with advanced illness can be successful on a large scale in supporting personal end-of-life care choices.