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US Cost-Effectiveness of Chimeric Antigen Receptor T-Cell (CAR T) Therapy for Patients with Relapsed or Refractory Large B-Cell Lymphoma (R/R LBCL), Considering Infusion Setting and Payor Claims Data

Speaker(s)

Cummings Joyner AK1, Snider J2, Wade S3, Wang ST4, Buessing MG4, Johnson S4, Gergis U5
1Medicus Economics, LLC, Miami, FL, USA, 2Kite, A Gilead Company, Santa Monica, CA, USA, 3Wade Outcomes Research and Consulting, Salt Lake City, UT, USA, 4Medicus Economics, LLC, Milton, MA, USA, 5Thomas Jefferson University Hospital, Philadelphia, PA, USA

Presentation Documents

OBJECTIVES: This US payer-perspective model compares lifetime costs and benefits for CAR T-treated R/R LBCL patients, by product (axicabtagene ciloleucel [axi-cel] vs. tisagenlecleucel [tisa-cel] / lisocabtagene maraleucel [liso-cel]), accounting for CAR T infusion setting (inpatient vs. outpatient) within authorized treatment centers.

METHODS: We applied unit costs to Anlitiks All-Payor Claims (AAPC) summary utilization data (2016-2020; N=1175), stratified by infusion setting, cytokine release syndrome (CRS), and neurologic event (NE) status, to estimate three-month costs following CAR T infusion. CAR T product- and setting-specific grade 3+ CRS/NE incidence rates were imputed from published trial data assuming higher rates among those infused in an inpatient setting. Quality-adjusted life-years (QALYs) and long-term costs (3% annual discount) were calculated using published product-specific overall and progression-free survival data without respect to setting. Direct costs of other LBCL treatments, intravenous immune globulin, and end-of-life care were also included. In the base-case, an outpatient proportion (17%) derived from AAPC was assumed for all products. Other base-case inputs for axi-cel were informed by ZUMA-1 trial cohorts 1 & 2. Alternative scenarios included outpatient proportions of 0% and 34% and data from ZUMA-1 cohort 4 and cohort 6 with updated safety management.

RESULTS: Under all scenarios, total QALYs for axi-cel exceeded those for tisa-cel (7.4 vs. 5.1) and liso-cel (7.7 vs. 5.9). In the base case, total costs for axi-cel exceeded those for tisa-cel ($632K vs. $577K) and liso-cel ($637K vs. $621K). Three-month post-infusion costs ranged from $57K to $59K across all products. Results were not sensitive to alternative outpatient proportions or inputs informed by ZUMA-1 cohort(s), including grade 3+ CRS/NE incidence. In all scenarios, axi-cel was cost-effective vs. both comparator products at maximum willingness-to-pay of $30K/QALY.

CONCLUSIONS: Axi-cel is a cost-effective CAR T option for patients with R/R LBCL compared to tisa-cel and liso-cel, regardless of infusion setting.

Code

EE359

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Genetic, Regenerative and Curative Therapies, Personalized and Precision Medicine