Cohort Identification and Outcomes
A cohort of patients aged 1-25 years, with ALL who received CAR-T
therapy between Oct 2016 and Dec 2021 in the United States was
identified. CAR-T product administration was confirmed with use of
ICD-10 codes for non-specific or specific CAR-T products: XW033C3,
XW033C7, XW033J7, XW043C3, XW043C7, XW043J7; or the CPT code for the
administration itself: 0540T. ALL diagnosis was confirmed based on
ICD-10 diagnostic codes: C91.00, C91.01, C91.02. To be included,
individuals were required to have had continuous insurance coverage for
30 days prior to and 60 days after CAR-T product administration, unless
patient death occurred during this time period. This time frame was
chosen to include the majority of therapy-related complications while
avoiding variation from pre-leukapheresis salvage therapies and
potential post-infusion relapse therapies.
Outcomes of interest included both cost and utilization of care. Here,
cost is defined as total reimbursement paid by the commercial payer.
Inpatient cost corresponds to claims with a place of service at an
inpatient hospital, and outpatient cost correspond to a place of service
at an office or hospital-based outpatient clinic. Utilization was
summarized as inpatient days, inpatient encounters, and outpatient
encounters. An inpatient encounter corresponded to claims with an
inpatient place of service with distinct start and end dates, and an
outpatient encounter was defined as a unique physician claim with the
place of service either being an office or hospital-based outpatient
clinic.