New IQVIA report highlights barriers to CAR T-cell therapy access across Europe, Canada and Australia

A new report from IQVIA outlines the key challenges limiting timely and equitable access to CAR T-cell therapies, including hospital capacity, referral systems and funding gaps across multiple countries.

The report, titled ‘Achieving CAR T-cell Therapy Health System Readiness: An Assessment of Barriers and Opportunities’ explores health system barriers that affect the delivery of CAR T-cell therapies in Europe, Canada and Australia. Drawing on 2024 data from IQVIA’s CAR T-Cell Therapy Monitor and clinical expert insights, the report highlights country-specific issues related to hospital capacity, geographic access, referral coordination and policy planning.

According to the report, while CAR T-cell therapies offer transformative potential for patients with relapsed or refractory cancers, access remains uneven due to limited treatment capacity, fragmented referral processes and complex administrative systems.

Hospital capacity remains a major constraint

Across all countries studied, the report identified limited hospital capacity as a leading barrier to timely treatment. In the UK and Italy, 28% of treating physicians said hospital resource limitations prevented some patients from receiving CAR T-cell therapy. Spain reported the same concern from 18% of physicians. A 2023 study cited in the report found that:

“Numbers of hematologists, nurses, and beds were the most important limiting factors.”

The report outlines several examples where targeted investments have improved capacity. Tuscany’s Careggi University Hospital secured infrastructure funding. Spain improved treatment center throughput by decentralizing apheresis procedures. France increased leukapheresis capacity and moved some care to outpatient or referring hospitals, helping to reduce inpatient time.

Australia and Canada face similar issues. In Australia, ICU beds and apheresis machines are limited. The Australia Cell and Gene Therapy Association emphasized the need for a coordinated approach, noting that:

“There is no national strategy currently for cell and gene therapies. There is an important need for such a strategy and for all stakeholders in the ecosystem to work together to draft this.”

In Canada, the report notes that capacity constraints also affect ancillary services, including interventional radiology used for line insertions. “Healthcare professionals that are specialized in this area are at a premium,” said one CAR T provider.

Geographic disparities affect patient access

The report finds that location plays a significant role in access. In Italy, 5 of 20 regions lack CAR T treatment centers. In Spain, 25% of patients treated in Madrid came from other regions, travelling an average of 125 kilometers. Australia has just 7 adult CAR T centers, with no access in several states. In Canada, patients in rural or remote areas often decline treatment due to travel burdens and lack of support networks.

Referral systems and physician knowledge vary

Efficient referral pathways are essential, and the report highlights wide variation between countries. Spain and the UK have relatively structured systems, often leveraging transplant networks. Spain’s national CAR T-cell plan helped boost monthly applications from, “around 30 to over 70 due to new indications and treatments,” while nearly 90% of approval decisions were made within 24 hours.

In contrast, Italy and Germany face delays due to less coordinated systems and inconsistent physician education. A 2020 survey referenced in the report found that, “infrastructure and personnel for leukapheresis,” were among the top challenges in Italy. The report also notes that over 85% of referring physicians in Spain and 90% in the UK said they needed more information about CAR T-cell therapy.

Delays between referral and treatment are common

The report notes that delays after referral are a common barrier to timely CAR T-cell treatment. In Italy and Spain, only 38% of patients with diffuse large B-cell lymphoma (DLBCL) received therapy within a month of referral. In the UK, just 17% of patients were treated within a month, while 25% waited more than 3 months.

Vein-to-vein times, another critical metric tracked in the report, also vary significantly between countries. Spain reported an average of 36 days in Q2 2024, while Canada recorded the shortest average at 24 days. According to the report, administrative bottlenecks and limited ICU availability are key contributors to delays in the UK. It references one UK policy paper which states, “These delays are driven by capacity constraints.”

Funding mechanisms and data systems influence access

Variability in funding processes is also noted. In Spain, the report highlights the use of outcomes-based reimbursement with staged payments, supported by the national registry (VALTERMED).

In contrast, the report notes that Canada’s fragmented payer system often leads to delays and regional disparities. However, it points to Alberta as a positive example, where efficiency has improved through the use of full-time staff dedicated to managing registry reporting.

Australia faces similar challenges. According to the report, funding models differ by state, and costs beyond the drug itself, such as those for infrastructure and clinical support services, are not always covered. Even so, the report highlights the ANZTCT registry as a valuable tool for tracking long-term patient outcomes and supporting both post-marketing surveillance and reimbursement reporting.

Policy planning is key for future demand

According to the report, countries with structured policy planning are better positioned to meet growing demand. Spain’s national CAR T-cell plan, launched in 2018 and regularly updated, is highlighted as a best-practice model. The UK is piloting outpatient care approaches and forecasting needs via the ATMP Coordinating Group. France has reduced inpatient burden by outsourcing lymphodepletion to referring hospitals. One study cited in the report found a median stay of 14 days in the referred group compared to 20 days in the standard group.

Cross-country differences highlight need for collaboration

The report concludes that France currently leads in CAR T uptake, followed by Spain and Germany, while the UK and Italy trail due to funding and coordination challenges. However, Italy has a higher proportion of referred patients who ultimately receive treatment, suggesting gaps in referral initiation elsewhere.

The report emphasizes that tackling these issues will require coordinated action. As it concludes,

“Ensuring that these best practices are well understood and scaled up... will require action involving funding, policy, and operational solutions by stakeholders across the healthcare system.”