Cost-Effectiveness of Chimeric Antigen Receptor T Cell Therapy in Patients with Relapsed or Refractory Large B Cell Lymphoma: No Impact of Site of Care.

in Advances in therapy by Alice Kate Cummings Joyner, Julia Thornton Snider, Sally West Wade, Si-Tien Wang, Marric G Buessing, Scott Johnson, Usama Gergis

TLDR

  • The study compared the cost-effectiveness of CAR T cell therapies axi-cel, liso-cel, and tisa-cel for treating relapsed/refractory large B cell lymphoma, finding axi-cel to be a cost-effective option at a maximum willingness-to-pay of under $26K/QALY.
  • Key Insights: Axi-cel showed higher total costs, but also provided more quality-adjusted life-years and incremental survival gains compared to liso-cel and tisa-cel.

Abstract

Cost-effectiveness data on chimeric antigen receptor (CAR) T cell therapies for relapsed/refractory large B cell lymphoma (R/R LBCL), accounting for inpatient/outpatient site of care (site), are sparse. This payer model compares lifetime costs/benefits for CAR T cell-treated (axicabtagene ciloleucel [axi-cel], lisocabtagene maraleucel [liso-cel], tisagenlecleucel [tisa-cel]) patients with R/R LBCL in the USA. Three-month post-infusion costs were derived from unit costs and real-world all-payer (RW) site-specific utilization data for 1175 patients with diffuse R/R LBCL (CAR T cell therapy October 2017-September 2020). Therapy- and site-specific grade 3+ cytokine release syndrome (CRS) and neurologic event (NE) incidences were imputed from published trials. Lifetime quality-adjusted life-years (QALYs) and long-term costs were calculated from therapy-specific overall and progression-free survival data, adjusted for differences in trial populations. The base case used 17% outpatient site (RW) for all therapies. ZUMA-1 trial cohorts 1/2 informed other axi-cel base case inputs; ZUMA-1 cohorts 4/6 data (updated safety management) supported scenario analyses. Base case total costs for axi-cel exceeded liso-cel ($637 K versus $621 K) and tisa-cel ($631 K versus $577 K) costs. Three-month post-infusion costs were $57 K to $59 K across all therapies. Total QALYs for axi-cel also exceeded those for liso-cel (7.7 versus 5.9) and tisa-cel (7.2 versus 5.0) with incremental costs per QALY gained of $9 K versus liso-cel and $25 K versus tisa-cel. Base case incremental net monetary benefit was $255 K (95% confidence interval (CI) $181-326 K) for axi-cel versus liso-cel, and $280 K (95% CI $200-353 K) versus tisa-cel. Longer survival with axi-cel conferred higher lifetime costs. In all scenarios (e.g., varied outpatient proportions, CRS/NE incidence), axi-cel was cost-effective versus both comparators at a maximum willingness-to-pay of under $26 K/QALY as a result of axi-cel's higher incremental survival gains and quality-of-life. Axi-cel is a cost-effective CAR T cell therapy for patients with R/R LBCL compared to tisa-cel and liso-cel. Site of care does not impact the cost-effectiveness of CAR T cell therapy.

Overview

  • The study aims to evaluate the cost-effectiveness of chimeric antigen receptor (CAR) T cell therapies for relapsed/refractory large B cell lymphoma (R/R LBCL) in the USA, focusing on the costs and benefits of axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel), and tisagenlecleucel (tisa-cel) from a payer perspective.
  • The study derives data from real-world all-payer site-specific utilization data for 1175 patients with diffuse R/R LBCL who received CAR T cell therapy between October 2017 and September 2020.
  • The primary objective is to compare the lifetime costs and benefits of CAR T cell-treated patients with R/R LBCL, accounting for inpatient and outpatient sites of care.

Comparative Analysis & Findings

  • The study found that axi-cel exceeded liso-cel and tisa-cel in total costs, with base case total costs of $637K versus $621K and $631K versus $577K, respectively.
  • Axi-cel also showed higher total quality-adjusted life-years (QALYs) compared to liso-cel and tisa-cel, with increments of $9K and $25K per QALY gained, respectively.
  • In all scenarios, axi-cel was found to be cost-effective versus both comparators, with incremental net monetary benefits of $255K and $280K versus liso-cel and tisa-cel, respectively, at a maximum willingness-to-pay of under $26K/QALY.

Implications and Future Directions

  • The study highlights the importance of considering site-specific costs and benefits when evaluating the cost-effectiveness of CAR T cell therapies.
  • Future studies should aim to examine the long-term costs and benefits of CAR T cell therapies in real-world settings, including the impact of site of care and treatment-related complications.
  • These findings can inform healthcare decision-making and resource allocation, particularly for patients with R/R LBCL who may benefit from CAR T cell therapies.
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