Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
Nausheen Ahmed , Ernie Shippey , Crissy Kus , Allison Appenfeller , Marc Steven Hoffmann , Aung M. Tun , Siddhartha Ganguly , Leyla Shune , Clint Devine , Rajat Bansal , Sunil H. Abhyankar , Muhammad Umair Mushtaq , Joseph McGuirk
Background: Axicabtagene ciloleucel and tisagenlecleucel are commercially available CD19 chimeric antigen receptor T-cell (CART) therapies for B cell malignancies. Manufacturing pharmaceutical companies require patients to stay within 2 hours of the center for 4 weeks post infusion. Most centers require local lodging for that period if residence is over 30 minutes away. Financial burden may limit access. We therefore hypothesized that those who were likely to receive CART therapies were from higher income neighborhoods or lived closer to the facility. Methods: Since most patients get admitted for CART infusion, we used the Vizient CDB database for CART infusion admissions as well as other admissions. Patients over the age of 18 yrs who got commercially available CART between 2018 to 2020 were included. Distance was calculated in miles from patient zip code to treating center. Using census data, lower income neighborhoods (less than $40,000 median household income) were flagged. Results: 81 centers administered CART. We calculated the distance in miles between the patient and the center for both CART admissions as well as for all-cause inpatient admissions. Most admissions (81.2% all-cause vs 78.6% CART) were from neighborhoods with median income > $40,000. Most of the low-income admissions were from neighborhoods <10 miles (13.3% all admissions vs 15.7% CART). 80.6% of all CART patients came from neighborhoods over 10 miles, with 38.2% living over 60 miles away, while only 15.4% all-cause admissions were from > 60 miles. (p<.0001) While 74.9% of higher income CART patients lived beyond 10 miles from center, only 5.7% CART patients lived beyond 10 miles. Results summarized in Table. Conclusions: Most CART patients lived over 10 miles from the center, however less than 10% of them were from lower income neighborhoods. Neighborhood location relative to center and household income influence access and need to be addressed.
Distance Range | All Admissions n (%) | CART cases n(%) | p value |
---|---|---|---|
Less than 10 miles all neighborhoods | 5,733,410 (46.7%) | 1,010 (19.4%) | p<.0001 |
Neighborhoods with income>$40,000 | 4,104,484 (33.4%) | 196 (3.7%) | p<.0001 |
Low income neighborhoods * | 1,628,926 (13.3%) | 814 (15.7%) | p<.0001 |
10-59 miles all neighborhoods | 4,643,441(38%) | 2,203 (42.4%) | p<.0001 |
Neighborhoods with income>$40,000 | 4,312,907 (35.3%) | 2116 (40.7%) | p<.0001 |
Low income neighborhoods * | 330,534 (2.7%) | 87 (1.7%) | p<.0001 |
60+ miles all neighborhoods | 1,892,270 (15.4%) | 1,983(38.2%) | p<.0001 |
Neighborhoods with income>$40,000 | 1,531,312 (12.5%) | 1,775(34.2%) | p<.0001 |
Low income neighborhoods * | 360,958 (2.9%) | 208( 4%) | p<.0001 |
Total admissions | 12,269,121 (100%) | 5,196(100%) | |
* - Patients living in neighborhoods with (based on Zipcode) with median household income below $40,000. |
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