From November 14 to 17, 2024, the Cellular Therapy and Immunotherapy Conference (CTI) was held in Hangzhou, China. The event gathered top experts, scholars, and industry leaders in cellular and immunotherapy, serving as a global platform for academic exchange and showcasing cutting-edge developments. During the conference, Hematology Frontier had the opportunity to interview Dr. William Hwang Ying Khee, CEO of Duke-NUS Medical School and the National Cancer Centre Singapore. Professor Hwang provided an in-depth exploration of the cost-effectiveness of CAR-T cell therapy, highlighting its unique advantages in cancer treatment and its promising potential to balance cost and efficacy.Key Highlights
- Long-Term Benefits: The cost-effectiveness of CAR-T cell therapy lies in its long-term efficacy. Unlike therapies requiring frequent administration and carrying a high risk of relapse, CAR-T offers extended treatment intervals and the potential for clinical cure.
- Context Matters: Cost-effectiveness evaluations must consider therapy and disease specificity, as well as variations in GDP and living costs across countries, which affect pricing and overall economic assessments.
- Targeted Effectiveness: Certain CAR-T therapies, such as those for second-line treatment of diffuse large B-cell lymphoma, show high cost-effectiveness, while therapies for other diseases are still under evaluation.
- Lowering Costs: Advances in technology and manufacturing efficiency, particularly in China, are key to reducing costs and improving affordability.
- Emerging Therapies: CAR-NK cell therapy offers a new perspective for cost reduction, with promising data from studies such as those at MD Anderson Cancer Center.
Q1: How do you view the cost-effectiveness of CAR-T cell therapy in improving cancer patients’ survival rates and quality of life? What factors influence its cost-effectiveness?
Dr. William Hwang Ying Khee: When evaluating the cost-effectiveness of CAR-T cell therapy, it is essential to take a long-term perspective. Many traditional therapies require monthly administration over extended periods, often with high relapse rates. These ongoing treatments not only incur significant costs but also reduce patients’ quality of life due to the burden of continuous therapy.
In contrast, CAR-T cell therapy is a one-time treatment that allows patients to remain treatment-free for a long period. In some cases, patients achieve complete remission and even clinical cure. From a lifetime cost perspective, CAR-T therapy demonstrates superior cost-effectiveness compared to therapies requiring continuous administration.
However, we must also consider the specificity of the product and the disease. Cost-effectiveness varies significantly between products and indications. Additionally, incremental cost-effectiveness differs across countries due to variations in GDP, living costs, and the pricing of CAR-T therapies. Each country must independently assess the cost-effectiveness of CAR-T therapies for specific indications based on these factors.
Q2: Are there differences in the cost-effectiveness of CAR-T therapies for various types of hematological cancers? What are the main areas of difference?
Dr. William Hwang Ying Khee: The cost-effectiveness of CAR-T therapies varies significantly depending on the disease and the specific product used. These differences are primarily based on results from large clinical trials tailored to particular indications.
For example, one specific CAR-T product for second-line treatment of diffuse large B-cell lymphoma has shown superior long-term outcomes in overall survival and event-free survival. This has translated into higher cost-effectiveness for this indication.
On the other hand, some CAR-T therapies targeting diseases like multiple myeloma have not demonstrated such significant effectiveness ratios. The cost-effectiveness of these therapies remains under evaluation as further data is collected.
Q3: What strategies can be employed to improve the cost-effectiveness of CAR-T cell therapy?
Dr. William Hwang Ying Khee: Improving cost-effectiveness hinges on two core strategies: reducing costs and enhancing efficacy. Technological advancements have enabled more efficient manufacturing processes, significantly lowering costs. In this regard, China has taken the lead in reducing the cost of CAR-T cell therapies.
Improving the efficacy of CAR-T therapies is equally important. If these therapies can deliver outcomes far superior to standard treatments—offering longer-lasting effects with fewer side effects—their cost-effectiveness will naturally increase.
Another promising development is CAR-NK cell therapy, which offers a unique approach. Unlike CAR-T, where each patient requires individually engineered cells, CAR-NK therapies allow one donor to potentially provide treatment for multiple patients. This could significantly reduce manufacturing and administration costs, improving overall cost-effectiveness.
For instance, studies at MD Anderson Cancer Center have shown that cord-derived CAR-NK cells can effectively eliminate tumors and survive in the body for at least a year after transplantation. These findings are exciting and indicate that CAR-NK therapy could be a game-changing innovation in the future of cancer treatment.
Conclusion
CAR-T cell therapy has demonstrated remarkable cost-effectiveness in cancer treatment, thanks to its long-term efficacy and potential for clinical cure. However, its cost-effectiveness depends on several factors, including therapy specificity, disease type, and economic conditions in different countries.
Advances in technology and manufacturing are gradually reducing costs, while emerging approaches like CAR-NK cell therapy are paving the way for more accessible and affordable treatment options. As research progresses, CAR-T and CAR-NK therapies are poised to play an increasingly important role in delivering effective and economically viable cancer treatments, offering new hope to patients worldwide.
About Dr. William Hwang Ying Khee
• CEO of Duke-NUS Medical School and the National Cancer Centre Singapore
• Renowned expert in cellular immunotherapy and hematologic malignancies
• Leading researcher in the cost-effectiveness of CAR-T cell and emerging CAR-NK cell therapies
