Real-World Treatment Patterns and Out-of-Pocket Costs After CAR T-Cell Therapy in Commercially Insured Patients with B-Cell Non-Hodgkin Lymphoma in the United States

CAR T-cell therapy has transformed the treatment of B-cell non-Hodgkin Lymphoma (NHL), yet treatment failure remains a major concern. Clinical trial data indicate relapse rates up to 50% within 6 months, but real-world evidence on salvage therapy patterns and financial burdens is limited. This study aims to assess the risk of CAR T failure risk, characterize subsequent therapeutic strategies, and quantify patient out-of-pocket (OOP) health care costs. We conducted a retrospective cohort study using the Merative MarketScan database (2017-2022), identifying adult patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), or primary mediastinal large B-cell lymphoma (PMBCL) who received CAR-T therapy. Additional therapy post-index indicated relapse, with cumulative risk estimated via Kaplan-Meier analysis. OOP costs, including copayments, coinsurance, and deductibles, were calculated. Among 224 eligible patients (median age: 57 years, 70% male, 83% DLBCL), 85 (38%) initiated subsequent therapy, with a cumulative failure risk of 36% at 6 months and 48% at 12 months. Lenalidomide was the most common salvage therapy in DLBCL. Six-month total OOP costs distributed across 121 patients were $273,676, with outpatient claims comprising 67%. Patients requiring additional therapy had higher mean OOP costs ($3,221 versus $1,806), with some reaching $38,889. This study underscores the persistent need for effective salvage therapy options and the financial burden of treatment failure. As CAR T-cell therapy is increasingly utilized in earlier treatment lines, future research should focus on optimizing post-CAR T-cell management and mitigating financial toxicity.