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Weighing the Cost-Effectiveness of Immunotherapy Combinations for Patients With DLBCL

By: Joseph Fanelli
Posted: Tuesday, January 17, 2023

Although first-line therapy with the antibody-drug conjugate polatuzumab vedotin-piiq plus rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) and second-line CD19 chimeric antigen receptor (CAR) T-cell second-line therapy have shown improvements in progression-free survival for many patients with diffuse large B-cell lymphoma (DLBCL), the treatments are unlikely to be cost-effective in the United States or Canada compared with the current standard of care, according to findings presented in the Journal of Clinical Oncology. Thus, health-care systems must balance the costs and uncertain incremental benefits of such immunotherapy combinations, concluded Anca Prica, MD, MSc, of the Princess Margaret Cancer Centre, Toronto, and colleagues.

“Expert analysis from policymakers is required to determine the appropriateness of funding these therapies,” the study authors said.

In this analysis, a Markov model was constructed to compare four treatment strategies for patients with newly diagnosed intermediate-to-high–risk DLBCL: polatuzumab vedotin and R-CHP plus second-line CAR T-cell therapy for early relapse; polatuzumab vedotin and R-CHP plus second-line salvage therapy with or without autologous stem cell transplantation; rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (the standard of care) plus second-line CAR T-cell therapy for early relapse; and the standard of care plus second-line salvage therapy with or without autologous stem cell transplantation.

Lifetime costs, quality-adjusted life-years evaluations, and incremental cost-effectiveness ratios were calculated from the perspective of U.S. and Canadian subjects, plus a willingness-to-pay threshold for both countries. In a probabilistic analysis with 10,000 simulations, the authors found that each strategy was incrementally more effective than the previous strategy—but also more expensive. Adding polatuzumab vedotin/R-CHP to the standard treatment had an incremental cost-effectiveness ratio of $546,956 USD and $245,381 CAD. Adding a second-line CAR T-cell therapy to the standard treatment had an incremental cost-effectiveness ratio of $309,813 USD and $303,163 CAD. In addition, simultaneously adding both polatuzumab vedotin/R-CHP and second-line CAR T-cell therapy to the standard treatment had an incremental cost-effectiveness ratio of $488,284 USD and $267,050 CAD.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.


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