Trends and Disparities in Chimeric Antigen Receptor T-Cell Therapy Utilization, Inpatient Mortality, Length of Stay,...

Since Food and Drug Administration (FDA) approval in August 2017, chimeric antigen receptor T-cell (CAR-T) therapy has rapidly transformed the treatment landscape of relapsed or refractory hematologic malignancies. However, national data describing variation in adoption across disease indications, sociodemographic groups, hospital characteristics, and geographic regions remain limited. In addition, real-world data describing inpatient outcomes, including mortality, length of stay (LOS), and hospitalization costs, remain incompletely understood. We aimed to investigate trends in inpatient CAR-T utilization by disease indication, sociodemographic factors, and hospital characteristics, as well as trends in inpatient outcomes including LOS, mortality, and hospitalization costs following FDA approval. We conducted a serial cross-sectional analysis using the National Inpatient Sample from 2017 to 2022 to evaluate trends in inpatient CAR-T utilization across patient and hospital characteristics and associated outcomes, including LOS, mortality, and costs. Survey-weighted generalized linear models with design-based standard errors calculated using Taylor series linearization were used for continuous outcomes. Binary outcomes were analyzed using survey-weighted logistic regression, with results reported as odds ratios with 95% confidence intervals (CIs). CAR-T adoption increased from 70 cases in 2017 to 4725 cases in 2022, corresponding to an annual growth rate of 32.6%. Non-Hodgkin lymphoma remained the most common indication, accounting for more than 50% of recipients. Multiple myeloma (MM) emerged as the second most common indication, representing a 79% increase from 13.1% in 2018 to 23.5% in 2022 following recent regulatory approvals. White patients comprised the majority of recipients (57.1% to 74.1%), and individuals in the highest income quartile consistently represented the largest proportion (27.8% to 37.4%). Uptake among patients aged ≥65 yr increased substantially, nearly equaling younger patients by 2022, consistent with this demographic shift. The proportion of CAR-T hospitalizations with Medicare as the primary payer increased from 25.2% in 2018 to 40.6% in 2022. Most CAR-T therapies were administered in large private hospitals (∼75%). Inpatient mortality remained stable at approximately 3%. LOS decreased by 1.16 d annually, while mean hospitalization costs increased by approximately $28,400 per year. Inpatient CAR-T utilization has expanded rapidly in the United States, particularly among older adults and patients with MM following recent indication expansion. Persistent sociodemographic disparities remain, with higher utilization among White, higher-income, and privately insured patients, highlighting ongoing challenges in equitable access to cellular therapy. Although LOS has decreased and inpatient mortality has remained stable, rising hospitalization costs reflect the growing economic burden and increasing resource utilization associated with CAR-T delivery. These findings provide important real-world insights into the evolving implementation of CAR-T therapy and may help inform strategies to optimize access and healthcare resource allocation as cellular therapies continue to expand.