Assessing Canadaʹs Health System Readiness for Complex Therapies - The Current and Future State of T-Cell Redirecting Therapies

Background: Interventions are considered complex when a number of factors associated with their use contribute to their health system impact (i.e., costs and effectiveness). An emerging complex intervention is the use of T-cell redirecting therapy. These therapies change the behaviour of a patient’s T-cells to modify (usually amplify) an immune response. Feasible approaches to care delivery, or initiatives that may support the safe delivery of these therapies given their real potential for expansion were identified. In doing so, the purpose of this report is to identify alternative feasible approaches to care delivery, or initiatives that may support the safe delivery and access to care of complex therapies in the Canadian and other health systems; Methods: readiness for complex therapies was explored using a mixed-methods approach. Information was sought using a conventional content approach and based on semi-structured interviews (30–60 min) and deliberation across key informants including patient representatives (n=2), healthcare system leaders/ administrators (n=2), and healthcare providers (n=11). (3); Results: This discussion revealed several insights for the future of complex therapies that will require attention including the need for: organizational change leadership and a change management function; specialized programs of care and implementation of navigational tools and educational strategies directed to providers and patients; trans-parent processes of evaluation that adhere to good practices in health technology assessment and implementation science; improving data collection to measure the cost and impact of new complex interventions; novel approaches to financing.