Cancer drugs costing more than $1 million could be drastically reduced in price by changes to the way immunotherapies are produced, opening up new opportunities for life-saving care.
Novel CAR T-cell therapies offering bespoke treatments are some of the most expensive to produce and deliver, making them out of reach the majority of patients.
The basic cost to deliver the therapy is at least $350,000, with additional licensing fees and other hospital expenses often pushing prices beyond the $1m mark.
Chimeric antigen receptor (CAR) T-cell therapy is used to treat some blood cancers, and is created by scientists to suit a patient’s genetics.
We believe every individual, regardless of their financial situation, deserves equal access to quality cancer care and support
Aisha Al Mulla,
Director of Friends of Cancer Patients
T-cells are collected from a patient, then re-engineered in the lab and delivered to the patient to hunt down and destroy cancerous cells.
But thanks to changes in manufacturing processes, hospitals around the world are beginning to produce their own CAR T-cell therapies locally, drastically cutting costs.
Caring Cross, a US-based non-profit organisation, aims to make gene therapy accessible and affordable worldwide, by decentralising manufacturing and opening up a new avenue of cancer care for all patients.
Cancer care boost
Dr Boro Dropulic, executive director of Caring Cross, said a global strategy could reshape healthcare and provide life-saving treatments for those who need them most.
“There are a number of ways the cost can be reduced, mainly by reducing the cost of materials used in the process,” Dr Dropulic told The National.
“The single largest cost is the vector used to deliver the therapeutic genes into cells. We are addressing this issue by establishing a public benefit corporation called Vector BioMed, which manufactures GMP Lentiviral vectors at about half the price of other manufacturers.”
The shipping of cells from hospitals to a large single central manufacturing facility and back is expensive to establish and maintain, he added.
“It is very costly when the number of products produced from such a facility does not reach capacity, which is generally the case. By bringing manufacturing of cells to the place where patients come for care, we can reduce the cost to a tenth of the current cost when coupled with simple and efficient manufacturing processes and materials,” Dr Dropulic added.
Local manufacturing
Caring Cross aims to bring manufacturing sites for personalised therapies to local hospitals around the world, improving access to the ground-breaking science. By developing low-cost CAR T-cell manufacturing processes, low and middle income countries such as Brazil can independently manufacture CAR T-cells and reduce dependency on expensive commercial products.
The approach bridges the healthcare gap, making advanced treatments more accessible to families facing financial barriers and promoting healthcare equity. Benefits of decentralised manufacturing are already being seen in Spain, where costs have plummeted to below $100,000, and in India where therapy costs have fallen to as low as $35,000.
Dr Dropulic said prefabricated modular ‘clean rooms’ are manufactured and deployed fully equipped for CAR T-cell manufacture anywhere in the world.
“The model is particularly suited for cellular gene therapies, which is our focus,” he said. “If this model works in low to middle income nations, it can definitely work in the UAE and similar countries.”
An estimated 20 million new cancer cases were reported worldwide in 2022, resulting in nearly 10 million deaths. For the millions affected, life-saving treatments like CAR T-cell therapy are far out of reach.
Doctors turn to the therapy when other treatments have failed, or a patient’s blood cancer has returned.
That comes at a cost with patients in the UAE often referred overseas for treatments.
“CAR T-cell has transformed the way we think about and see cancers, and there are multiple indications now approved,” said Dr Humaid Al Shamsi, director of medical oncology services at Burjeel Medical City.
“There is a huge interest to bring CAR T-cell from haematology, into other forms of cancers as it has transformed the way we treat blood cancers. For the solid tumours like GI cancer, lung cancer, breast cancer, it's still not quite there yet.
“There are many studies and trials happening right now, but currently it's only approved for blood cancer.”
Therapies are expensive due to the huge investment required for research and development.
Overseas care
Dr Al Shamsi said about 15 Burjeel Medical City patients had been referred for expensive CAR T-Cell therapies, with the US and Singapore the most common destinations.
High costs remained a prohibitive factor in bringing therapies to the UAE, but that could change.
“To bring these drugs from preclinical studies to advanced stages can cost billions,” said Dr Al Shamsi.
“Licensing fees are also significant, exceeding Dh50 million. To get a return, they [pharmaceutical companies] have to charge more than average to recover these costs.
“It’s important to understand this is a personalised treatment, as we have to perform processes in a special way to develop CAR T-cells for each patient, which takes a lot of effort.
“The infrastructure itself is also very costly to build. We can cut this down by making drugs more accessible, with more factories and more manpower to handle this, as the time to collect the CAR T-Cell can take around 35 days.”
In April, the UAE’s Friends of Cancer Patients charity covered some of the costs of CAR T-Cell therapy for a 46-year-old Omani man who lived in Ras Al Khaimah.
The immunotherapy cost more than Dh1 million, with some of those costs paid by the charity.
The man was successfully treated for lymphoma at the Yas Clinic in Khalifa City.
In the first half of 2024, FoCP supported 96 patients, including six children, with Dh4.3m in care fees.
Cancer is an expensive disease to treat, with some of the most effective immunotherapies out of financial reach for many.
Charity support
In 2023 the charity supported the care of 323 cancer patients with Dh7.2 million of funding to treat 55 different cancers.
“We believe every individual, regardless of their financial situation, deserves equal access to quality cancer care and support,” said Aisha Al Mulla, director of Friends of Cancer Patients.
“The financial burden of cancer can be overwhelming, but we are dedicated to alleviating this stress through our comprehensive support programmes.”
In the US, approximately 1.8 million new cancer cases are diagnosed annually, leading to an estimated $5.6 billion in out-of-pocket expenses for patients and their families.
Meanwhile in the UAE, the year 2022 saw 5,526 new cancer diagnoses, and 2,283 deaths.
“Our mission is to ensure that no one faces this battle alone,” said Ms Al Mulla.
“By offering moral and financial support, we aim to alleviate the stress associated with treatment costs and empower patients to focus on their recovery, nurturing an environment where hope prevails.”
Mohammed bin Zayed Majlis
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Stuck in a job without a pay rise? Here's what to do
Chris Greaves, the managing director of Hays Gulf Region, says those without a pay rise for an extended period must start asking questions – both of themselves and their employer.
“First, are they happy with that or do they want more?” he says. “Job-seeking is a time-consuming, frustrating and long-winded affair so are they prepared to put themselves through that rigmarole? Before they consider that, they must ask their employer what is happening.”
Most employees bring up pay rise queries at their annual performance appraisal and find out what the company has in store for them from a career perspective.
Those with no formal appraisal system, Mr Greaves says, should ask HR or their line manager for an assessment.
“You want to find out how they value your contribution and where your job could go,” he says. “You’ve got to be brave enough to ask some questions and if you don’t like the answers then you have to develop a strategy or change jobs if you are prepared to go through the job-seeking process.”
For those that do reach the salary negotiation with their current employer, Mr Greaves says there is no point in asking for less than 5 per cent.
“However, this can only really have any chance of success if you can identify where you add value to the business (preferably you can put a monetary value on it), or you can point to a sustained contribution above the call of duty or to other achievements you think your employer will value.”
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Emergency phone numbers in the UAE
Estijaba – 8001717 – number to call to request coronavirus testing
Ministry of Health and Prevention – 80011111
Dubai Health Authority – 800342 – The number to book a free video or voice consultation with a doctor or connect to a local health centre
Emirates airline – 600555555
Etihad Airways – 600555666
Ambulance – 998
Knowledge and Human Development Authority – 8005432 ext. 4 for Covid-19 queries
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Tightening the screw on rogue recruiters
The UAE overhauled the procedure to recruit housemaids and domestic workers with a law in 2017 to protect low-income labour from being exploited.
Only recruitment companies authorised by the government are permitted as part of Tadbeer, a network of labour ministry-regulated centres.
A contract must be drawn up for domestic workers, the wages and job offer clearly stating the nature of work.
The contract stating the wages, work entailed and accommodation must be sent to the employee in their home country before they depart for the UAE.
The contract will be signed by the employer and employee when the domestic worker arrives in the UAE.
Only recruitment agencies registered with the ministry can undertake recruitment and employment applications for domestic workers.
Penalties for illegal recruitment in the UAE include fines of up to Dh100,000 and imprisonment
But agents not authorised by the government sidestep the law by illegally getting women into the country on visit visas.
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Mohammed bin Zayed Majlis
