The Cost-Effectiveness of Axicabtagene Ciloleucel Versus Standard of Care As Second-Line Therapy in Patients With Large B-Cell Lymphoma in the Netherlands

OBJECTIVES: Axicabtagene ciloleucel (axi-cel) demonstrated superior overall survival versus standard of care (SOC; salvage chemoimmunotherapy followed by high-dose chemotherapy with autologous stem-cell transplantation for responders) in the treatment of relapsed or refractory large B-cell lymphoma (2L LBCL) in adults in the ZUMA-7 trial (NCT03391466). This study aimed to estimate the cost-effectiveness of axi-cel versus SOC in 2L LBCL from a Dutch health care perspective.

METHODS: Using a partitioned survival model, we estimated costs, life years (LYs), and quality-adjusted life-years (QALYs) over a lifetime time horizon. The model was populated with efficacy, safety, and utility inputs based on patient level data from ZUMA-7. Time-to-event data were extrapolated beyond the trial period (median follow-up 47.2 months) using mixture cure models validated by Dutch clinical experts. Medical resource use data and 2023-year unit costs in Euros (€) were obtained from the literature and Dutch price databases. Outcomes and costs were discounted at 1.5% and 4% per annum, respectively. Sensitivity and scenario analyses were conducted to assess results robustness.

RESULTS: 2L LBCL axi-cel treatment resulted in a QALY gain of 2.18 and incremental costs of €107,927 compared to SOC, resulting in an incremental cost-effectiveness ratio of €49,557 per QALY. The results were driven by better long-term survival and quality of life of patients in the axi-cel arm despite substantial utilization of chimeric antigen receptor-T cell therapy in third line in the SOC arm. Key model drivers included the standardized mortality ratio applied to general population mortality for long-term survivors treated with axi-cel and the cost of autologous stem cell transplantation. Including AE-associated disutilities and costs of axi-cel retreatment had a small effect on results.

CONCLUSIONS: Axi-cel is a cost-effective alternative compared to SoC for adult patients with 2L LBCL in the Netherlands therefore can be considered an efficient use of resources in the Netherlands.