Treatment for cancer is rigorous and often requires multiple strategies. Cancer drugs are among the most expensive medications in the world. The high treatment costs, prevalence, and severity of cancer mean that any new forms of treatment are met with equal parts excitement and suspicion. Will this novel treatment be effective or affordable?
Kristina Ellis, a Master’s candidate in the lab of Prof. William W.L. Wong, conducts research to answer some of these questions. She’s examining one of the most innovative cancer treatments in recent years: CAR T-cell therapy.
Chimeric-antigen receptor (CAR) T-cell therapy is a form of gene therapy designed to treat a subset of cancers of the blood and lymph nodes. It involves removing the T-cells of a patient with cancer, reprogramming those cells to attack the cancer, and then injecting them back into the patient’s body. It’s unlike any treatment currently in use. The first form of CAR T-cell therapy was approved by Health Canada in September 2018, and it’s anticipated that provincial and territorial regulatory bodies will soon be making decisions on how and when to fund the drug.
Kristina is conducting two projects that will generate findings to inform funding decisions about CAR T-cell therapy in a Canada. One is a qualitative study involving interviews with researchers, clinicians, policy makers, and other stakeholders with an interest in the new therapy.
“The goal of this part of the study is to improve our understanding of the process of developing the therapy and delivering it to patients in need,” she says.
The second component of the project is a quantitative cost-effectiveness analysis that will examine how CAR T-cell therapy compares, cost-wise, to the typical standard of care in patients with aggressive large B-cell lymphomas.
“Unfortunately for patients with these types of lymphomas, they’ve often tried a few treatments that haven’t had success,” says Kristina. “They have a poor prognosis and are treated with ‘salvage chemotherapy’ - the last effort when other drugs haven’t worked. It’s at this point that we would consider CAR T-cell therapy as an option.”
CAR T-cell therapy is exorbitantly expensive and while it can be successful for some patients, for others it can have serious and even fatal side effects such as triggering an aggressive immune system response. These risks make physician decisions about when to use the drug, and funding bodies’ decisions about when to cover the cost of the drug, especially challenging.
“By modelling the cost-effectiveness of CAR T-cell therapy, my research will generate findings that can support funding decisions about this new medication. I achieve this by inputting information such as efficacy and safety data, overall survival, and costs – of the drug, of the administration costs, of the adverse events, and more – I can build a model that will predict patient outcomes in the long-term, relative to the costs.”
Such economic models are standard resources for policy-makers, as they help ensure that funding decisions consider the wide variety of factors which impact paying for health care services. This type of work is new to Kristina, who first learned about economic modelling in a graduate class taught by her supervisor, Prof. William W.L. Wong.
“I had an interest in the cancer space from my time working at CADTH (Canadian Agency for Drugs and Technologies in Health) on the pan-Canadian Oncology Drug Review team. My thesis will contribute to a large-scale project that is a systems level policy model. It’s encouraging to play a role in comprehensive research that can inform health policy.”
After graduation, Kristina hopes to continue working in the health economics and informatics space. Her research has received support from BioCanRx.