Dr Michael Kolodziej Discusses Concerns Around Paying for Innovative Treatments, Like CAR T

While new therapies like chimeric antigen receptor (CAR) T-cell therapy, can have amazing results, the innovation of these treatments has outstripped the United States’ ability to pay for them, said Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.

Transcript

What is concerning you as medical innovations continue to advance treatment?

CAR T is unbelievable. I don’t know what percent of people are cured. My guess is it doesn’t cure nearly as many people as they say it cures, because that’s always what happens in oncology. But, let’s go back a half step. The ascension of IO [immuno-oncology] into the front line of therapy, now the potential for combined IO to increase efficacy, is amazing. And yet, our ability to understand how to pay for those really expensive therapies has not kept up with the science. In fact, the science has outstripped the ability to help patients. And, unfortunately, as a consequence, patients are not getting access to those therapies.

I mean, it is well known—well known—that CAR T for Medicare patients is largely a no-go if you’re a Medicare fee-for-service patient. Why? Because the compensation is inadequate. And every patient that’s treated in an academic medical center—or a CAR T center, many of them are academic—winds up costing that institution, on average, between $150,000 and $200,000. They lose that much money on every single patient. What kind of business can you run if you’re losing that much money on very patient? Which means we’re denying Medicare patients access to that potentially life-saving therapy, which, well I’m an oncologist, I’m very unhappy with that. That’s just not right.

Now we’re going to have gene therapy. Holy moly. We had an announcement from Novartis that it’s going to be $3 million for the gene therapy for spinal muscular atrophy, which is a horrible disease—it’s not very common. $3 million a patient. $3 million a patient. So, we better start thinking about what we need to do to allow our patients to have access to this therapy that could basically turn a disease that is both fatal and horrible on the way to fatal, into something that is cured.

That’s the thing that I think is the most interesting subject. And we better come up with some ideas, because the [International Pricing Index] is not going to fix that problem. It’s not even going to come close to fixing it. And I know that the European countries, the health technology assessment organizations, at [the National Institute for Health and Care Excellence in the United Kingdom], for example, they are really concerned that they don’t have the tool to decide how to accommodate this for their population.