Posted: Monday, March 6, 2023
An article published in JAMA Network Open highlighted the cost-effectiveness of chimeric antigen receptor (CAR) T-cell therapies as second-line or later options in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Mohamed Abou-el-Enein, MD, PhD, MSPH, of the Keck School of Medicine, University of Southern California, Los Angeles, and colleagues used a cost-effectiveness threshold of $150,000 per quality-adjusted life-year (QALY) and examined the cost-effectiveness of standard care versus two CAR T-cell therapies: axicabtagene ciloleucel and tisagenlecleucel. Their findings revealed that second-line axicabtagene ciloleucel and third-line or later tisagenlecleucel were the most cost-effective CAR T-cell choices in this patient population.
Model data were derived from two randomized clinical trials (ZUMA-7 and BELINDA) and the published literature. The cost-effectiveness model assessed each treatment strategy by comparing axicabtagene ciloleucel and tisagenlecleucel independently with salvage high-dose chemotherapy and consolidative autologous hematopoietic stem cell transplantation as the second-line therapy. The cost-effectiveness of tisagenlecleucel with salvage chemotherapy for refractory disease as the third-line or later therapy was also assessed. Costs and QALYs were used to derive incremental cost-effectiveness ratios for the U.S. health-care sector and societal perspectives.
Overall findings revealed that use of axicabtagene ciloleucel in the second-line setting was associated with an incremental cost-effectiveness ratio of $99,101 per QALY from the health-care sector and $97,977 per QALY from the societal perspective. Although use of tisagenlecleucel in the second-line setting was dominated by standard care, use of tisagenlecleucel in the third-line or later setting was associated with an incremental cost-effectiveness ratio of $126,593 per QALY from the health-care sector and $128,012 per QALY from the societal perspective. For patients achieving prolonged progression-free survival who would not incur disease progression–related costs, the incremental cost-effectiveness ratio changed to $125,962 per QALY from the health-care sector and $122,931 per QALY from the societal perspective. These findings suggest that CAR T-cell therapy may be cost-effective but still needs further analysis to delineate individual value gains.
Disclosure: For full disclosures of the study authors visit, jamanetwork.com.