Cost-Effectiveness of the Brexu-Cel in Relapsed/Refractory Mantle Cell Lymphoma and B-Cell Acute Lymphoblastic Leukemia: A Systematic Review

OBJECTIVES: To explore the existing evidence on the cost-effectiveness analysis (CEA) of Brexucabtagene autoleucel (brexu-cel) across different international jurisdictions.

METHODS: A systematic search of articles on Embase, Medline, Econlit, Web of Science, Scopus, grey literature, and Health Technology Assessment (HTA) reports was done until 25 November 2023. Original English articles and HTA reports from different countries assessing the cost-effectiveness of brexu-cel in mantle cell lymphoma (MCL) and acute lymphoblastic leukemia (ALL) were included.

RESULTS: Of the total 136 records, 25 articles underwent full-text review after the title and abstract screening, 5 met the inclusion criteria and were included with 4 HTA reports from Australia, Canada, Scotland, and England. The CEA studies were from the US, England, Canada, and Italy, with varying perspectives, e.g., healthcare and third-party payers. The discount rates in these studies varied between 1.5% and 5% annually. The lifetime horizon was considered uniformly, mainly using a partitioned survival model. The model input data from the ZUMA-2 and ZUMA-3 trials were used for brexu-cel, with comparators from their respective trials or literature. The comparators varied across these CEA studies, which included the standard of care (SoC) treatment and/or salvage therapy for relapsed/refractory (R/R) MCL and R/R ALL. Brexucel’s incremental cost-effectiveness ratios (ICERs) were £67,713, €64,798, $88,503, and $31,985 per quality-adjusted life year (QALY) versus the respective comparators in England, Italy, Canada, and the US, respectively. Brexu-cel was found cost-effective in England, Scotland, Italy, and the US but inconclusive in Canada and Australia. Some key influencing parameters of cost-effectiveness results included the drug acquisition costs and long-term survival assumptions.

CONCLUSIONS: The ICERs of Brexu-cel per QALY were relatively high across the various countries. However, the cost-effectiveness results were contingent on the model uncertainties and clinical data extrapolation for the long-term effect, which should be carefully considered when making treatment decisions.