Cost-effectiveness of chimeric antigen receptor T-cell therapy in multiply relapsed or refractory adult large B-cell lymphoma.

Abstract

7561 Background: Two anti-CD19 chimeric antigen receptor T-cell therapies are approved for large B-cell lymphoma (DLBCL): axicabtagene ciloleucel (axi-cel) and tisagenlecleucel. Each costs $373,000 (wholesale acquisition). We evaluated each therapy’s cost-effectiveness. Methods: A decision analytic Markov model evaluated axi-cel and tisagenlecleucel in multiply relapsed/refractory adult DLBCL from a US health-payer perspective over a lifetime horizon. The model was informed by recent multi-center, single-arm clinical trials. Under a range of plausible long-term effectiveness assumptions, axi-cel and tisagenlecleucel were each compared with salvage chemoimmunotherapy regimens and stem-cell transplantation. Main outcomes were un-discounted life-years, discounted lifetime costs, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (3% discount rate). Sensitivity analyses explored uncertainty. Results: In an optimistic scenario, assuming 40% five-year progression-free survival (PFS), axi-cel increased life-expectancy by 8.15 years at $129,000/QALY (95% UI: $90,000-215,000/QALY) gained. At 30% five-year PFS, improvements in life-expectancy were more modest (6.4 years) and expensive ($159,000/QALY [$107,000-281,000/QALY] gained). In an optimistic scenario, assuming 35% five-year PFS, tisagenlecleucel increased life-expectancy by 4.6 years at $168,000/QALY ($104,000-453,000/QALY) gained. At 25% five-year PFS, improvements in life-expectancies were more modest (3.4 years) and expensive ($224,000/QALY [$124,000-1,190,000/QALY] gained). Administering CAR-T to all indicated patients would increase US healthcare costs by $10 billion over 5 years. Price reductions to $250,000 or payment only for initial CR or 90-day CR/PR (at current prices) would allow both therapies to cost < $150,000/QALY down to 25% PFS. Conclusions: At current prices, it is possible that each CAR-T therapy may meet a < $150,000/QALY threshold; this is dependent on long-term benefit compared with chemoimmunotherapy and SCT, which is uncertain. Widespread adoption would increase non-Hodgkin lymphoma healthcare costs substantially. Price reductions or payment for initial CR or 90-day CR/PR would favorably influence cost-effectiveness even if long-term outcomes are modest.

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

“…QALYs) and non-mixture cure modeling (4.32 QALYs) than reported in Lin et al [24] (2.82-3.92 QALYs). Total costs for tisa-cel were estimated to be comparable to slightly higher than reported in the literature.…”

“…Notwithstanding the improved outcomes and increased costs associated with CAR T therapy compared to salvage chemotherapy (with gains of approximately 2 to 8 years of life at increased costs of approximately $350,000 to $490,000 across prior cost-effectiveness models comparing CAR T to chemotherapy [24][25][26][27]), limited information is available regarding comparative cost effectiveness among these CAR T therapies. The present analysis was conducted to assess from a US payer perspective the cost effectiveness of axicel versus tisa-cel for the treatment of r/r LBCL among patients who previously received ≥2 lines of systemic therapy.…”

CAR‐T TREK through the lymphoma universe, to boldly go where no other therapy has gone before

“…This process entails high production costs that might limit access to this therapy in healthcare systems based on private insurance or patients without adequate financial resources. 58 Another issue is eligibility for autologous T-cell collection. Currently, commercially available CART therapy requires a blood lymphocyte count of at least 100-300 lymphocytes/µl to collect sufficient cells for manufacturing.…”

Allogeneic CAR Cell Therapy—More Than a Pipe Dream

“…However, this strategy would only benefit the subset of patients determined to be at high-risk of needing CAR therapy early on in their disease process. Lastly, autologous cell therapy is performed for individual patients and is associated with significant costs, limiting broader applications of this therapy ( 16 , 17 ).…”