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

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Key findings</h4>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.<h4>Conclusions</h4>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.