The effect of centralising novel cell therapies for solid cancers - a health systems planning model for Europe

Integrating cell therapies for solid cancers requires centralising services to ensure high quality and poses unique challenges for all healthcare systems. In this national population-based study, we modelled the effect of different centralisation scenarios in the English NHS on travel times, equity and hospital capacity as an archetype to inform European planning.

We identified 10,050 patients treated with systemic therapy for metastatic colorectal cancer in 139 NHS hospitals between 2016 and 2018. Seven hypothetical scenarios A-G centralised cell therapy services to between 15 and 51 centres. For example to A) 51 comprehensive cancer centres; or D) 15 CAR-T centres. For each scenario reallocation of patients to the designated specialist centre was based on patient preferences using conditional logistic regression models; travel times were calculated using a geographic information system; multivariable linear regression models estimated the variation in travel burden across demographic characteristics.

For each centralisation scenario there was a 3 times increase in predicted travel time. Centralising services to comprehensive cancer centres (scenario A) had the smallest impact on travel time (additional 40.9 min); 72 % of patients remained within 1 h of specialist services. Centralisation to existing CAR-T centres (scenario D) resulted in 44 % of patients not having access to a facility within 1 h. For 5 scenarios additional travel burden disproportionately affected low socioeconomic groups.

Localisation of solid cancer cell therapy services in Europe requires a balance between access, equity, and clinical safety. This modelling approach can be used in all European health systems, to understand the pre-implementation impact of centralisation to inform optimum service design and mitigations.