Real-World Study Shows $330,000 Cost Difference Between CAR T and BiTE Therapies | AMCP Nexus 2025

The use of a bispecific T-cell engager (BiTE) to treat patients with relapsed refractory follicular lymphoma demonstrated a lower average total cost and lower rates of cytokine release and neurotoxicity compared with chimeric antigen receptor T-cell (CAR T) therapy, according to a real-world study by Prime Therapeutics and presented as a poster at the Academy of Managed Care Pharmacy (AMCP) Nexus. The meeting is being held at the Gaylord National Resort and Convention Center in National Harbor, Maryland, outside of Washington.

Follicular lymphoma is a slow-growing form of non-Hodgkin’s lymphoma that arises from B-lymphocytes. It accounts for 20% to 30% of all non-Hodgkin’s lymphoma cases. Patients often relapse after initial treatment.

Both CAR T-cell therapies and BiTEs are types of immunotherapies. Both types of therapies are approved for third-line use for patients with relapsed refractory follicular lymphoma, but there is debate among clinicians about which one to use first. Three CAR T products are FDA approved, with the first Yescarta (axicabtageneciloleucel) approved in 2021, and two BiTEs, starting with Lunsumio (mosunetuzumab) in 2022

“Even though providers have traditionally preferred CAR T because of their high response rates in relapsed disease, we are for the first time in an era where a BiTE may be considered along with CAR T,” Simone Ndujiuba, Pharm.D., BCOP, senior principal clinical oncology pharmacist at Prime Therapeutics, told Managed Healthcare Executive by email. “So, what does that mean for cost and adverse effects?”

Researchers at Prime wanted to compare the 12-month total cost of care and the adverse event incidence for patients treated with CAR T versus BiTE therapy in relapsed refractory follicular lymphoma.

They conducted a retrospective, observational cohort study and analyzed integrated medical and pharmacy claims from 17 million commercial, 1.4 million Medicaid, and 950,000 Medicare members from Dec. 1, 2021, to March 31, 2024. They identified members initiating either Lunsumio, a BiTE therapy, or a CAR T therapy, including Kymriah (tisagenlecleucel), Yescarta (axicabtagene ciloleucel) or Breyanzi (lisocabtagene maraleucel).

The researchers note that a BiTE therapy, Epkinly (epcoritamab-bysp), was approved in June 2025 and was not included in this analysis.

Researchers Included in the cost of care: the study therapy; other treatments for relapsed refractory follicular lymphoma; lymphodepletion and CAR T preparation; and supportive care. A total of 30 BiTE and 31 CAR T patients met all study inclusion criteria. One patient was treated through Medicaid and was removed from the analysis.

Prime researchers found that the CAR T cohort had a significantly higher average total cost of care compared with the BiTE cohort: $702,000 vs. $372,000. Among the studied therapies, drug costs were significantly higher in the CAR T cohort ($521,000, representing 74% of total cost of care) compared with $183,000 (49% of total cost of care).

“What was most surprising was the difference in drug cost,” Ndujiuba said. “During the timeframe studied, CAR T drug cost was nearly double that of BiTE for both commercial and Medicare lines of business. Also, the place of service for BiTE therapy, even though there are challenges transitioning to outpatient, most doses were administered in the hospital outpatient setting with some in non-hospital settings. Even though there is a movement to transition CAR T to the outpatient setting, the majority of CAR T was administered in the inpatient setting.”

Researchers found that adverse events occurred in 52% of CAR T patients and 23% of BiTE patients. The costs associated with these adverse events were significantly higher in the CAR T group: $9,000 compared with less than $500 in the BiTE group.

Ndujiuba said Prime will continue to monitor utilization of CAR T and BiTE therapies, especially as newer BiTEs enter the market. “We’ll also continue to evaluate changes in sites of care for both CAR T and BiTEs. As we receive data, we plan to continue to share the story of the evolution of these novel therapies.”