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Cost-Effectiveness of Anti-BCMA CAR T-Cell Therapy in Triple-Class Refractory Multiple Myeloma

Speaker(s)

Barnes JI1, Frosch ZA2, Garfall AL3, Vogl D3, Lin J3
1University of Washington, Seattle, WA, USA, 2Fox Chase Cancer Center, Philadelphia, PA, USA, 3University of Pennsylvania, Philadelphia, PA, USA

OBJECTIVES: Idecabtagene vicleucel (ide-cel), an anti-BCMA chimeric antigen receptor T-cell (CAR-T) therapy (list price $419,500), was approved in 2021 by the US FDA for triple-class refractory multiple myeloma (MM). Another anti-BCMA CAR T-cell therapy, ciltecabtagene autoleucel (cilta-cel), is undergoing FDA review. We evaluated the cost-effectiveness of ide-cel and cilta-cel (assuming price parity with ide-cel).

METHODS: A partitioned survival model evaluated ide-cel and cilta-cel in triple-class relapsed/refractory MM from a US health-payer perspective over a lifetime horizon. Comparators included conventional therapies, belantamab mafodotin-blmf, selinexor-dexamethasone, and salvage autologous stem-cell transplantation. Main outcomes were life-years, lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Future costs and benefits were discounted at 3% per year. We assumed a cost-effectiveness threshold of $150,000/QALY and used probabilistic analyses with 10,000 simulations to evaluate uncertainty.

RESULTS: Ide-cel increased life expectancy by 0.96 years and cost $672,122/QALY gained (95% UI, $498,146-1,008,033) compared with conventional therapy. Cilta-cel increased life expectancy by 2.26 years and cost $295,897/QALY gained (95% UI, $147,591-436,745) compared with conventional therapy. Both CAR T-cell therapies exceeded the cost-effectiveness threshold when compared with the other therapies. Although CAR-T increased life expectancies, because virtually all patients ultimately progress, the high cost of subsequent standard myeloma care ($312,000/year) worsened the overall cost-effectiveness of CAR-T: large price reductions to $32,462 (ide-cel) and $120,850 (cilta-cel) are necessary to meet a $150,000/QALY threshold. If the cost of subsequent care were lowered to conventional cost-effectiveness thresholds, more modest price reductions to $188,802 (ide-cel) and $324,739 (cilta-cel) are needed.

CONCLUSIONS: Ide-cel and cilta-cel are projected to substantively increase life expectancy, but neither is cost-effective at current prices. To meet a $150,000/QALY threshold, the price of ide-cel and cilta-cel need to be reduced by 55% and 23% respectively, and improvements in the cost-effectiveness of subsequent multiple myeloma care are also needed.

Code

EE41

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Oncology