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Institute Report
Achieving CAR T-cell Therapy Health System Readiness
An assessment of barriers and opportunities
Mar 20, 2025
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Report Summary:

In this report, the current health system capacity for delivering CAR T-cell therapies to patients was assessed in seven countries (Australia, Canada, France, Germany, Italy, Spain, and the United Kingdom). This includes reimbursement and funding, patient referral, treatment, and long-term follow-up. This report provides background on the complex CAR T-cell therapy patient journey from patient identification and referral to long-term monitoring, and estimates CAR T-cell therapy utilization in a subset of countries.

Key barriers and best practices for enhancing the delivery of CAR T-cell therapies are also highlighted for each country. Based on this assessment and learning from best practices, potential solutions are provided to improve patient access to CAR T-cell therapies. This report is intended to provide a foundation for discussions around key barriers and actions or policies that could be tailored to specific country or regional needs to ensure the full potential of CAR T-cell therapies is realized.

Key Findings:

  • Treatment with CAR T-cell therapy is complex and requires the coordination of a multi-disciplinary team including referring and treating physicians, nurses, and pharmacists, along with other stakeholders that can vary by country, region, or hospital.
  • CAR T-cell therapy share varies across Italy, France, Germany, Spain, and the United Kingdom. The differences in CAR T-cell therapy share uptake among the countries can be driven by several factors, such as the number of treatment centers, the processes for referrals and treatment initiation/administration, and reimbursement dynamics.
  • The analysis of barriers across these dimensions throughout the CAR T journey highlights several issues that can limit optimal delivery in the countries studied in this analysis. These barriers vary across countries. For example, some countries and regions have a well developed referral system, such as France and Australia, while others face substantial challenges at this level, as in Italy and Germany.
  • All countries studied are experiencing issues around capacity and staffing; experts that were interviewed expressed concerns about the workload of current healthcare staff involved with these therapies.
  • The average turnaround times (vein to vein) ranged from 36 days in Spain to 24 days in Canada in Q2 2024. Additionally, the time between referral and commencement of CAR T treatment for DLBCL varies substantially across countries. Across all countries, there were a large proportion of cases that took two months.
  • Some key solutions can be considered to enhance the use of CAR T-cell therapies for eligible and appropriate patients based on identified best practices across countries. These steps will need to be reviewed and adapted for specific national or regional contexts.

Other Findings:

CAR T-cell therapy system and patient journey

  • Treatment with CAR T-cell therapy requires the coordination of a multi-disciplinary team including referring and treating physicians, nurses, pharmacists, along with the patients and their caregivers.
  • Policy leaders are also key stakeholders as they shape the overall environment, fund these often-expensive treatments and can direct investments that focus on enhancing overall processes in the healthcare system.

Share of patients treated with CAR T-cell therapies among drug treated LBCL 2L+ R/R CAR T naïve patients (Evolution between 2022 and 2023)

  • The overall share varies across countries. France had the highest share of patients receiving CAR T in 2023 with 30% and Italy the lowest (11%).
  • Several factors can drive these differences in CAR T share such as the number of treatment centers, the processes for referrals and treatment initiation/ administration, and reimbursement dynamics.

Share of referring providers by level of information received about CAR T-cell therapy, Q2 2024

  • Referring physicians in France, Australia, and Canada note a higher level of knowledge regarding CAR T-cell therapies compared to other countries in scope
  • However, additional information and education programs may be beneficial in all countries with a substantial proportion of referring physicians noting the need for more information

Time between referral and commencement of CAR T treatment, Q2 2024

  • The time between referral and commencement of CAR T treatment for DLBCL varies substantially across countries. Treating physicians in UK and Australia noted the highest proportion of times that were three months or greater
  • Across all countries, there were a large proportion of cases that took two months. These delays after referral can be driven by capacity constraints and operational issues which need to be addressed.

Share of referred patients receiving CAR T treatment, Q2 2024

  • An assessment of the share of referred patients receiving CAR T-cell treatment across countries for DLBCL in Q2 2024 highlights a higher proportion of patients being treated in Italy and Spain compared to other countries. This suggests that other countries may be facing additional challenges postreferral.
  • It should be noted that while Italy has a high proportion of referred patients being treated, it has the lowest share of overall LBCL 2L+ patients receiving CAR T, highlighting that not all patients who may be eligible are referred and the referral process has been noted as a major barrier in Italy

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