Cost-Effectiveness of Axicabtagene Ciloleucel Versus Other CAR T-Cell Therapies in the Treatment of Diffuse Large B-Cell Lymphoma in France

OBJECTIVES:

The annual incidence of diffuse large B-cell lymphoma (DLBCL) in France is 5071 people per year. 10-15% of DLBCL patients have primary refractory disease and one in three relapse following first-line therapy. Prior to the availability of chimeric antigen receptor (CAR) T-cell therapy, the prognosis for relapsed or refractory (r/r) DLBCL was poor, with a median overall survival of 6.3 months. The efficacy and safety of axicabtagene ciloleucel (axi-cel; a CAR T-cell therapy) was evaluated in the single-arm phase II ZUMA-1 trial, which demonstrated durable responses, a median overall survival of 25.8 months and a 43% survival rate at 5 years. This analysis assessed the cost-effectiveness of axi-cel versus other CAR T-cell therapies (tisagenlecleucel [tisa-cel] and lisocabtagene maraleucel [liso-cel]) in the treatment of r/r DLBCL, from a French healthcare system perspective.

METHODS:

A partitioned survival model was used to extrapolate costs and quality-adjusted life years (QALYs) over a lifetime time horizon. Two matching-adjusted indirect comparisons were performed to reweight the patient population from ZUMA-1 to better reflect the patient populations in each of JULIET (tisa-cel) and TRANSCEND (liso-cel). Survival curves for progression-free survival and overall survival were based on independent mixture cure models fitted to the JULIET, TRANSCEND, and reweighted ZUMA-1 data. Utility values were derived from ZUMA-1 and costs were obtained from French registries and published sources. Costs and outcomes were discounted at an annual rate of 4%. List prices for axi-cel and tisa-cel were used, but as there is no publicly available price for liso-cel, the French list price of tisa-cel was used.

RESULTS:

Axi-cel is associated with incremental cost-effectiveness ratios of €15,470 and €17,841 compared with tisa-cel and liso-cel, respectively; incremental QALYs are 2.09 and 1.73, respectively.

CONCLUSIONS:

Compared with other CAR T-cell therapies, axi-cel is expected to represent a cost-effective use of French healthcare resources.