Cost effectiveness of axicabtagene ciloleucel versus tisagenlecleucel for adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy in the United States

Abstract

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

Cost-Effectiveness Analysis of Axicabtagene Ciloleucel vs. Tisagenlecleucel for the Management of Relapsed/Refractory Diffuse Large B-Cell Lymphoma in Spain

“…Other possibly relevant AEs, such as cytopenias or infections, were excluded from the analysis. Furthermore, no disutility values were attributed to AEs similar to other economic evaluations developed for axi-cel [14,16].…”

“…Recently, a cost-utility analysis developed from the USA payer perspective for the same comparators presented axi-cel as a dominant alternative vs. tisa-cel, resulting in higher QALY gained (+2.31 discounted) and slightly lower costs (−$1407) [14]. QALY gained for axi-cel vs. tisa-cel were equal from USA and Spanish payer perspectives, however total costs were higher for tisa-cel in the USA analysis, in contrast with our analysis where axi-cel showed higher costs.…”

“…A previously developed decision-analytic model in Microsoft Excel ® (Excel 365, Microsoft, Redmond, WA, USA) was adapted to estimate over a lifetime horizon (maximum of 50 years) the costs and health benefits, in terms of LYG and QALY, accrued for a hypothetical cohort of adult patients with R/R DLBCL after ≥2 lines of systemic therapy who received axi-cel or tisa-cel [14]. According to the approach commonly used in advanced stage oncology models, a PS-MCM was utilised for both treatment arms.…”

The role of additional chemotherapy prior to autologous HCT in patients with relapse/refractory DLBCL in partial remission—A retrospective multicenter study

“…Several analyses have been recently conducted to evaluate the cost‐effectiveness and budget impact of anti‐CD19 CAR‐T therapies from a US‐payer perspective. Anti‐CD19 CAR‐T therapy cost $373 000 for a one‐time infusion, not accounting for expenses associated with hospitalizations, ICU stays, and treatment of toxicities while the estimated cost of salvage chemotherapy and HCT range between $145 000 and $195 000 17–19 …”

Cost-effectiveness of Axicabtagene Ciloleucel and Tisagenlecleucel as Second-line or Later Therapy in Relapsed or Refractory Diffuse Large B-Cell Lymphoma

“…CAR T cell treatment costs were modeled according to observed hospitalization data from the JULIET trial as reported in Yang et al 22 Inpatient and ICU costs were calculated separately. 23 Adverse event costs were estimated based on grade 3 or greater adverse events with incidence rates greater or equal to 5%, including cytokine release syndrome and neurotoxic effects (eTable 2 in Supplement 1). CAR T cell therapy travel-related out-of-pocket costs were reported to be different across settings and thus were included as informal costs.…”