A new report by IQVIA acknowledges the national strategy, the network of designated centres and the monitoring of outcomes, whilst highlighting inequalities in access and barriers relating to capacity and funding

consalud.es / Spain stands out in Europe for its model of access to CAR-T therapies

CAR-T cell therapies have transformed the treatment of advanced haematological malignancies. Since its first regulatory approval in 2017, this therapy has offered a highly viable alternative for patients who have exhausted conventional treatment options. However, despite various clinical advances, access to these therapies remains unequal. In 2023, for example, treatment rates stood at 30 per cent in France and just 11 per cent in Italy.

Against this backdrop, a new report published by IQVIA examines how policy action can enable healthcare systems to deliver CAR-T therapies equitably and at scale. The analysis, in fact, sets out policy recommendations across six interdependent dimensions of healthcare system readiness: governance, funding, facility readiness, staff development and specialisation, patient referral pathways, and outcome monitoring.

The same report, entitled ‘The Government’s Role in Optimising the Healthcare System’s Preparedness for CAR-T Cell Therapies’, concludes that Spain has the most comprehensive framework for the administration of CAR-T therapy in the whole of Europe. Since 2018, Spain has been monitoring treatment applications by indication, geographical coverage in referral hospitals, response times from the Expert Group and the network of designated centres; a plan which, according to IQVIA, our country “continues to refine”. One of the examples cited is that of shortcomings in geographical coverage, which led to successive expansions of the network of centres. In this regard, the 2025–2028 plan drawn up by the National Health System (SNS) extends the model to all advanced therapies.

Globally, the report argues that many CAR-T therapy centres are operating at or near full capacity, which continues to create bottlenecks as demand rises. It therefore argues that a shared-care, outpatient model could expand capacity without compromising outcomes. Another key point highlighted in the report is that DRG-based reimbursement rarely fully covers the non-therapeutic costs of administering CAR-T therapy, meaning that hospitals may be forced to absorb these costs and patients may have to bear travel-related expenses. The study highlights practices in Australia, where patient travel assistance schemes funded by the Australian government cover travel and accommodation for patients and carers.

The report acknowledges the Spanish model for having a specific national strategy

Another issue is that there are shortcomings in most of the functions relating to CAR-T therapy. The analysis reveals that nursing staff continue to be underutilised, and also that the administrative burden diverts doctors’ time away from patient care. In the United Kingdom, for example, the ATTC Network provides a set of National Health Service (NHS) readiness tools comprising over 64 training resources for healthcare professionals. Furthermore, non-medical prescribing guidelines allow qualified nurses and pharmacists to prescribe subsequent cycles of systemic cancer therapy.

In the area of patient referral, the report highlights the Spanish initiative for the Early Identification and Referral of Lymphoma Patients Eligible for CAR-T Therapies (IDEaL), which aims to facilitate the early identification of eligible patients and improve the referral of lymphoma patients. The document presents IDEaL as an example of how a national strategy can be translated into disease-specific decision-making tools and help to formalise referral pathways.

Overall, the document concludes that no single measure is sufficient on its own to guarantee sustainable and equitable access to CAR-T therapies. Furthermore, it recognises the Spanish model for its specific national strategy, a network of designated centres, eligibility assessment mechanisms and an outcomes monitoring platform. Meanwhile, the report identifies as a general challenge the need to improve the visibility of the entire patient journey, including those who are candidates for therapy but do not end up receiving it.