To assess from a US payer perspective the cost-effectiveness of the chimeric antigen receptor T (CAR T)-cell therapies axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) to treat relapsed or refractory (r/r) large B-cell lymphoma (LBCL) following ≥2 systemic therapy lines. Methods A 3-state (i.e., pre-progression, post-progression, death) partitioned survival model was used to estimate the quality-adjusted life-years (QALYs) and costs for patients on each treatment over a lifetime horizon. Progression-free survival (PFS) and overall survival (OS) were based on a matchingadjusted indirect treatment comparison (MAIC) that accounted for differences in trial population baseline characteristics. Mixture-cure models (MCMs) were used to account for long-term survivors. Costs included drug acquisition and administration for the CAR T-cell therapies and conditioning chemotherapy, apheresis, CAR T-specific monitoring, transplant, hospitalization, adverse events, routine care, and terminal care. Health state utilities were derived from trial and published data. Sensitivity analyses included probabilistic sensitivity analyses (PSAs) and an analysis of extremes that assessed the results across a vast array of combinations of parametric OS and PFS curves across the 2 therapies. Results Compared to tisa-cel, axi-cel resulted in 2.31 QALYs gained

But : Décrire les aspects diagnostiques et thérapeu-tiques du cancer du sein. Méthodologie : C'est une étude rétrospective (mars 1999-juillet 2008) dans deux hôpitaux de Bamako au Mali. L'examen histologique a été effectué chez tous les malades. Résultats : Nous avons colligé 210 malades (205 femmes et cinq hommes) avec un âge moyen de 47,4 ans. Cinquantesept (27,14 %) malades avaient un antécédent de pathologie bénigne du sein ; chez 47 patients, le cancer du sein dans la famille a été retrouvé. La prise d'estroprogestatifs a été évo-quée par 59 patientes. Nous avons retrouvé 32 métastases osseuses, 56 pulmonaires et 43 métastases hépatiques. Nous avons effectué 138 mastectomies avec curage ganglionnaire selon Patey contre 21 cas de chirurgie conservatrice. La morbidité postopératoire a été de 13,81 %. L'examen histologique a révélé un cancer canalaire infiltrant chez 120 (57,14 %) malades et un carcinome lobulaire infiltrant chez 45 (21,43 %) malades. Cinquante-six (26,67 %) malades étaient de stade TNM I + II, 122 (58,10 %) malades étaient positifs au récepteur estrogénique (RE). Cent quatorze (54,86 %) malades ont bénéficié d'une hormonothérapie ou chimiothérapie, nous n'avons pas fait de radiothérapie. Dans le groupe des 97 malades qui avaient un recul de cinq ans, la survie à cinq ans a été de 37,1 %. Conclusion : Le pronostic du cancer du sein est grave au Mali. Mots clés Cancer · Sein · MaliAbstract Aim: To describe clinical and therapeutic aspects of breast cancer. Methodology: We made a retrospective study (March 1999-July 2008 in two hospitals of Bamako (Mali). The histological examination was done in all the cases. Results: We selected 210 patients (205 women and 5 men); the mean age was 47.4 ± 13.6 years and the extremes of 21 and 82 years. Fifty-seven women (27.14%) had antecedents of benign pathology of breast. Breast cancer occurred in a family member in 47 patients. The administration of estroprogestatives for contraception was found in 59 patients. We found 32 cases of bone metastases, 56 cases of pulmonary metastases, and 43 cases of hepatic metastases. We carried out 138 mastectomies with lymphadenectomy (Patey) and 21 quadrantectomies with lymphadenectomy. The morbidity after surgery (abscess of partition lymphoedeme) was 13.81% (29 cases). The histological examination revealed an infiltrating canal cancer in 120 cases (57.14%) and an infiltrating lobular carcinoma in 45 cases (21.43%). We classified 56 patients (26.67%) under stage TNM I + II, 122 patients (58.10%) were estrogen receivers positive. One hundred fourteen patients (54.86%) have benefited of chemotherapy or hormonotherapy but any radiotherapy. In the group of 97 patients who had a long-term follow-up, survival at 5 years was of 37.1%. Conclusion: The prognostic of breast cancer is serious in Mali.

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Objective Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSoCT) versus PSoCT alone from a US Medicare perspective. Methods A four-state Markov model (alive prior to heart failure hospitalization, alive during heart failure hospitalization, alive post-heart failure hospitalization, and death) was developed to predict clinical and economic outcomes, based on the results of the VICTORIA trial, in which patients with chronic HFrEF following a worsening heart failure were randomized to placebo or vericiguat, in addition to PSoCT, which consisted of β-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan. Risks of heart failure hospitalization and cardiovascular mortality were based on multivariable regression models derived from VICTORIA data. Utilities were derived from VICTORIA EQ-5D data and the literature. Costs included drug acquisition, heart failure hospitalization, routine care, and terminal care. Primary outcomes included heart failure hospitalization, cardiovascular mortality, life-years, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a 30-year lifetime horizon, discounted at 3.0% annually. Results For the VICTORIA overall intent-to-treat population, compared with PSoCT, vericiguat plus PSoCT resulted in 19 fewer heart failure hospitalizations and 13 fewer cardiovascular deaths per 1000 patients, as well as 0.28 QALY gained per patient at an incremental cost of $23,322, leading to $82,448 per QALY gained. Conclusions Based on the results of VICTORIA, patients treated with vericiguat had lower rates of heart failure hospitalization and cardiovascular death. The addition of vericiguat to PSoCT was estimated to increase QALYs and to be cost effective at a willingness-to-pay threshold of $100,000 per QALY gained.

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