Cost-Effectiveness Analysis of Tisagenlecleucel for Third-Line Treatment With Relapsed or Refractory Diffuse Large B-Cell Lymphoma Patients
Author(s)
Kuan-Wei Lai, Master1, Ming Yao, MD2, Bor-Sheng Ko, Ph. D.3, Sze-Hwei Lee, MD4, Jui-Che Chen, MD3, Hui-Chu Lang, MPH, PhD1.
1National Yang Ming Chiao Tung University, Taipei, Taiwan, 2Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan, 3Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, 4Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
1National Yang Ming Chiao Tung University, Taipei, Taiwan, 2Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan, 3Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, 4Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Presentation Documents
OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) is the most common and aggressive subtype of B-cell non-Hodgkin lymphoma, accounting for approximately 30% of all cases. Tisagenlecleucel, a chimeric antigen receptor T-cell (CAR-T) therapy, has demonstrated favorable efficacy in clinical trials and is covered under Taiwan's National Health Insurance (NHI) for adult patients with relapsed or refractory DLBCL (R/R DLBCL) who have failed two or more lines of therapy. However, no cost-effectiveness analysis using real-world data specific to Taiwan has been conducted. The study aimed to evaluate the cost-effectiveness of tisagenlecleucel compared to high-dose chemotherapy combined with allogeneic hematopoietic stem cell transplantation (allo-SCT) as the third-line treatment with R/R DLBCL patients from the payer’s perspective in Taiwan.
METHODS: A three-state partitioned survival model was developed from the perspective of the NHI to assess the cost-effectiveness of tisagenlecleucel compared to allo-SCT. Efficacy data were sourced from the Taiwan Society of Blood and Marrow Transplantation database. Transplantation’ s efficacy and costs were obtained from a medical center in Taiwan. Utility data were drawn from the published literature. Base case analysis applied a 3% discount rate, with a 20-year analytic horizon. The willingness-to-pay (WTP) threshold was set based on Taiwan's 2023 per capita GDP to assess cost-effectiveness. Main outcomes included total incremental costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Deterministic and probabilistic sensitivity analyses were conducted.
RESULTS: The base case analysis showed that tisagenlecleucel resulted in incremental costs of NT$5,427,900 and additional effectiveness of 1.99 QALYs. The ICER was NT$2,725,982/QALY. One-way sensitivity analysis demonstrated that the model was most sensitive to cost of tisagenlecleucel and discount rate. In probabilistic sensitivity analysis, at a WTP threshold of NT$3,086,904/QALY, tisagenlecleucel had a 64.8% likelihood of being cost-effective.
CONCLUSIONS: Compared to allo-SCT, tisagenlecleucel is a cost-effective treatment for R/R DLBCL patients from the payer’s perspective in Taiwan.
METHODS: A three-state partitioned survival model was developed from the perspective of the NHI to assess the cost-effectiveness of tisagenlecleucel compared to allo-SCT. Efficacy data were sourced from the Taiwan Society of Blood and Marrow Transplantation database. Transplantation’ s efficacy and costs were obtained from a medical center in Taiwan. Utility data were drawn from the published literature. Base case analysis applied a 3% discount rate, with a 20-year analytic horizon. The willingness-to-pay (WTP) threshold was set based on Taiwan's 2023 per capita GDP to assess cost-effectiveness. Main outcomes included total incremental costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Deterministic and probabilistic sensitivity analyses were conducted.
RESULTS: The base case analysis showed that tisagenlecleucel resulted in incremental costs of NT$5,427,900 and additional effectiveness of 1.99 QALYs. The ICER was NT$2,725,982/QALY. One-way sensitivity analysis demonstrated that the model was most sensitive to cost of tisagenlecleucel and discount rate. In probabilistic sensitivity analysis, at a WTP threshold of NT$3,086,904/QALY, tisagenlecleucel had a 64.8% likelihood of being cost-effective.
CONCLUSIONS: Compared to allo-SCT, tisagenlecleucel is a cost-effective treatment for R/R DLBCL patients from the payer’s perspective in Taiwan.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE270
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology