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Chimeric antigen receptor (CAR) T-cells are a cellular immunotherapy with remarkable efficacy in treating multiple hematologic malignancies but they are associated with extremely high prices that are, for many countries, prohibitively expensive.

As their use increases both for hematologic malignancies and other indications, and large numbers of new cellular therapies are developed, novel approaches will be needed both to reduce the cost of therapy, and to pay for them.

We review the many factors that lead to the high cost of CAR T-cells and offer proposals for reform.

Price negotiation -- such as through the Inflation Reduction Act -- offers a key opportunity to reduce the prices of CAR T-cells by more closely aligning them with the value that they offer patients.

Furthermore, increasing transparency and reducing the price of the bundle of care negotiated between hospitals and insurers also has the potential to substantially affect the total cost of administering CAR T-cells.

Autologous CAR T-cells are costly to produce because of their patient-specific nature and complex manufacturing process -- novel approaches to manufacturing such as allogeneic CAR T-cells may reduce manufacturing costs.

Addressing these extremely high prices would help to ensure that CAR T-cell therapies are accessible to patients who may benefit from them, without placing an unsustainable burden on healthcare systems.

Read an interview about the review here.