Gilead - March 2019 - case study 2

CAR T-cell therapy is a specialist and advanced class of cell and gene therapy treatments that use genetically engineered T-cells to recognise and target cancers. Gilead Sciences has been proud to partner with NHS England and local centres alongside Novartis in supporting England to make CAR T therapy available from 2018, initially for patients with a form of leukaemia, and subsequently for patients with a type of non-Hodgkin lymphoma. [10] CAR T was subsequently made available for use in Scotland and Wales.

CAR T therapies have now been available to patients in England for nearly four years and are delivered across 14 specialist sites in the UK for adult patients as of October 2022. The NHS’s rapid adoption of these personalised therapies has been impressive, demonstrating agility, ambition and collaboration in overcoming the wide range of unique challenges these complex therapies present.

However, data suggests that while CAR T has been routinely available to patients in England for coming up to four years, significant variation in access remains. In the case of diffuse large B cell lymphoma (DLBCL), hospital episodic statistics (HES) data suggests that there may be inequality in access to CAR T for patients from areas with higher levels of deprivation. In the period from 2019 to March 2022, this data shows that only 11.7 per cent of CAR T-treated patients came from the most deprived quintile of the population, compared to 23.8 per cent from the least deprived quintile. [12] While this deprivation quintile variation does also exist for patient care across the entire DLBCL patient population, it appears to be more pronounced for patients infused with CAR T.

This data also suggests that wider regional inequality in access to CAR T may exist. In 2021, there appeared to be fewer CAR T infusions for patients diagnosed in the Southwest and in a belt across the North than in other areas.

Based on analysis of HES data and Gilead’s own internal data, Gilead are concerned that patients in certain areas of the country appear to face challenges in access to CAR T therapies. HES data from 2019 to 2022 may suggest that no or very limited numbers of patients in either the Northeast region near Hull or areas of the Southwest including Cornwall have been treated with CAR T since it was made available. There are also indications that treatment rates have recently improved in certain areas of the Northeast and Southwest, although this is not yet reflected in the available data.

If this data is accurate, Gilead are concerned it appears to be mirrored in wider health disparities facing people in both the Northeast and Southwest – who tend to suffer from poorer health outcomes and wait longer for care than those in other areas of the country:

Life expectancy is 12.7 years lower for men and 10.2 years lower for women in Kingston upon Hull than in England’s least deprived areas. In Cornwall, the under 75 mortality rates from cancer is 127.1 per 100,000 people – around the national average, but much worse than the best areas of the country which have a rate of 87.4 per 100,000.

Cancer waiting times in Hull CCG are also higher than those in other areas of the country, with 57.07 per cent of patients receiving treatment within the targeted 62-days from referral compared to a national target of 85 per cent. In NHS Kernow CCG – the NHS area that covers Cornwall – 73.63 per cent of patients are seen within 62 days.

As such, Gilead would welcome the opportunity to discuss the challenges captured above in further detail, and to explore how industry can collaborate with local teams to ensure equitable access to innovative treatments across the country.

Job Bag Number: UK-UNB-4242

Date of Preparation: July 2023