[Estimating the real price of CAR-T cells in France: From list price to net price].

INTRODUCTION

CAR-T cells represent a breakthrough in relapsed or refractory hematologic malignancies. In France, they are commonly associated with prices ranging from €300,000 to more than €400,000, based on early access indemnities and initial list prices. Yet these figures do not reflect the actual cost for the healthcare system, which is reduced by confidential rebates and pricing adjustments negotiated between companies and public authorities. This study aims to estimate the real (net) price of commercial CAR-T cells therapies in France and analyze the evolution of their public list prices over time.

METHODS

The WP5 "Value & Access" working group of the UNITC consortium conducted a document-based analysis using list prices published in the Journal Officiel (JO), therapeutic value assessments (SMR/ASMR) from the French Health Technology Assessment agency (HAS), early access prices, and average rebate rates reported by the public agency in charge of pricing negotiations (CEPS). A sensitivity analysis was conducted using various rebate scenarios.

RESULTS

Applying the 2023 average rebate rate for antineoplastics (36.2 %) yields an estimated median net price of €220,110. The sensitivity analysis, using rebate assumptions from 25 to 45 %, gives a median of €212,550 (IQR: €51,750). Public list prices have decreased by an average of 14 % at each new negotiation round.

CONCLUSION

While the list price published in the JO serves as a public and international benchmark, it does not reflect the actual financial burden. Net price represents only one part of the broader societal cost, which also includes organizational and infrastructure-related expenses.