The Cost and Value of CAR-T Therapy: Economic Considerations Behind the High Price

Introduction

CAR-T cell therapy stands as one of the most groundbreaking innovations in cancer treatment in recent years. By “reprogramming” a patient's own immune cells to recognize and attack cancer cells, this personalized therapy offers the prospect of cure for various hematologic malignancies—including lymphoma, leukemia, and multiple myeloma. Yet behind the miracle of CAR-T lies a significant economic burden.

Due to its highly complex manufacturing and administration processes, intensive treatment cycles, and potential for severe side effects, CAR-T therapy is exceptionally costly. In the United States, a single treatment carries a list price ranging from $420,000 to $540,000. When combined with hospitalization, nursing care, and other supportive treatments, total expenses can soar to $1 million. This “million-dollar therapy” has sparked widespread debate within the medical community and policy circles: Is such an expensive treatment truly “worth it”?

To assist healthcare insurers and policymakers in determining whether CAR-T therapy should be covered, scholars have conducted extensive economic evaluation studies. Most research focuses on two marketed CAR-T products: tisagenlecleucel for relapsed or refractory B-cell acute lymphoblastic leukemia (r/r B-ALL) and axicabtagene ciloleucel for diffuse large B-cell lymphoma (DLBCL). Findings generally indicate that CAR-T may be “cost-effective” for some patients, meaning that despite its high price, the additional life expectancy and quality-of-life improvements it offers may justify the expense.

This article summarizes the results from a systematic review to discuss the cost-effectiveness of CAR-T.

Cost-Effectiveness of CAR-T Therapy: What the Data Tell Us

Adult Patients: Significant Efficacy, but High Costs

In studies involving adult patients, nearly all cost-effectiveness analyses reach similar conclusions:

CAR-T therapy significantly improves survival and treatment response, but at a high cost.

Studies typically measure cost-effectiveness using the “incremental cost-effectiveness ratio” (ICER), which quantifies the cost per quality-adjusted life year (QALY) gained. This figure varies considerably across studies and indications:

For CAR-T drugs treating diffuse large B-cell lymphoma (DLBCL), such as Yescarta® (axicabtagene) or Kymriah® (tisagenlecleucel), the cost per QALY ranges from approximately $47,000 to over $4 million. For brexucabtagene, another CAR-T therapy for mantle cell lymphoma (MCL), ICERs range from $33,000 to $91,000. Therapies for multiple myeloma (MM), such as idecabtagene and ciltacabtagene, carry even higher costs, typically ranging from $120,000 to $330,000 per QALY. Key factors driving these variations include: the drug's procurement cost, assumptions about long-term survival after treatment, hospitalization duration, and price differences across national healthcare systems.

Some studies also compare the cost-effectiveness of different CAR-T products. For instance, several analyses found Yescarta® to be more “cost-effective” than Kymriah®, delivering greater health benefits at lower costs. However, recent analyses suggest another product (lisocabtagene) may offer greater cost advantages in certain scenarios. In other words, no single CAR-T therapy currently stands as the “most cost-effective” option across all circumstances.

Overall, the economic value of CAR-T therapy for adult patients remains contingent on whether long-term efficacy can be sustained. If the treatment delivers truly durable remission, its cost-effectiveness may fall within acceptable ranges for most healthcare systems; however, if recurrence rates are high or efficacy declines over time, cost-effectiveness could deteriorate rapidly.

Pediatric and Adolescent Patients: More Promising Returns

CAR-T therapy demonstrates relatively stronger economic performance in pediatric and adolescent populations.

Multiple studies indicate that Kymriah® for treating relapsed or refractory B-cell acute lymphoblastic leukemia (r/r B-ALL) achieves a cost-effectiveness range of approximately $20,000 to $246,000 per QALY in this cohort.

The key factor influencing outcomes remains the assumption regarding “cure rates.” If a significant proportion of children achieve long-term disease-free survival post-treatment, the ICER for CAR-T therapy could decrease to approximately $60,000 per QALY. Conversely, assuming persistently high long-term mortality risks would elevate the cost-effectiveness ratio to over $110,000 per QALY.

Furthermore, several studies introduced a societal perspective for the first time—meaning they considered not only medical costs but also factors like family caregiving, transportation/lodging, and lost workdays. Results indicate that when factoring in potential gains from parents returning to work and patients regaining productivity, CAR-T therapy even became a “cost-saving” option in some models. In other words, from a broader societal viewpoint, CAR-T demonstrates greater long-term value for pediatric patients.

Discussion

CAR-T therapy has transformed the treatment of certain blood cancers by helping some patients achieve long-lasting remission when other treatments have failed. However, our review of existing studies shows that while CAR-T therapy often provides better health outcomes, it also comes with very high costs. Whether or not it represents “good value for money” depends on many factors — such as the type of cancer, the patient’s age, and how long the benefits of treatment last.

One major challenge in studying CAR-T’s economic value is that most research still relies on limited or indirect comparisons between treatments. This means the true long-term effectiveness of CAR-T can be difficult to estimate. Because many of these studies are funded by pharmaceutical companies and not always fully transparent, there’s uncertainty about how generalizable their findings are. To better understand its real-world value, more independent studies using real-world patient data are needed.

Another key issue is that the cost of CAR-T therapy itself is complex and varies across countries and hospitals. Some nations, such as Germany and Italy, have introduced “pay-for-performance” systems, where payment is tied to patient outcomes. These systems aim to make the pricing fairer and reduce uncertainty for both patients and health systems. Over time, as manufacturing becomes more efficient and more treatment can happen outside hospitals, the cost of CAR-T therapy may gradually decrease.

Still, the high price tag limits access, especially in low- and middle-income countries where the therapy is rarely available. Moreover, because many studies on CAR-T’s cost-effectiveness are done in wealthier nations, it’s unclear how well their results apply to other settings.

Future research needs to be more consistent and transparent — using standard guidelines to model costs and benefits and including more diverse patient populations. This would help ensure that cost-effectiveness analyses better support healthcare decision-making and reimbursement policies.

Conclusion

In summary, CAR-T therapy represents an exciting breakthrough in cancer treatment, offering hope to patients with few other options. However, its high cost and uncertain long-term benefits make it challenging to determine whether it is truly cost-effective. The current evidence suggests that while CAR-T therapies tend to improve survival and quality of life, their overall economic value varies widely depending on the type of cancer, patient group, and assumptions used in studies.

To make informed decisions about expanding access to CAR-T therapy, health systems will need clearer economic guidelines, better long-term data, and fair pricing models. Continued research and innovation will be key to ensuring that these life-saving therapies become both medically effective and economically sustainable for patients worldwide.

Assessed and Endorsed by the MedReport Medical Review Board