An Economic Model to Estimate Costs of Adverse Events in Patients Treated With Lisocabtagene Maraleucel (liso-cel), Axicabtagene Ciloleucel (axi-cel), or Tisagenlecleucel (tisa-cel) for Relapsed/Refractory Follicular Lymphoma
Author(s)
Ashley C. Saunders, PharmD, MPh, MSc1, William Ngantung, BS2, Matia Saeedian, PharmD, MS2;
1Bristol Myers Squibb, Princeton, NJ, USA, 2BluePath Solutions, Los Angeles, CA, USA
1Bristol Myers Squibb, Princeton, NJ, USA, 2BluePath Solutions, Los Angeles, CA, USA
Presentation Documents
OBJECTIVES: Understanding economic implications of CAR T cell therapies and associated AEs is crucial for informed decision-making and to underscore key economic and safety differences across these therapies. We estimated total weighted per-patient cost of AEs (cytokine release syndrome [CRS], neurological events [NE], prolonged cytopenia, and serious infections) for patients with R/R follicular lymphoma (FL) treated with liso-cel, axi-cel, or tisa-cel utilizing rates reported in the TRANSCEND FL (NCT04245839), ELARA (NCT03568461), and ZUMA-5 (NCT03105336) studies.
METHODS: A decision tree economic model was developed using AE rates (by grade) from TRANSCEND FL, ELARA, and ZUMA-5 studies (median follow-up of 18.9, 16.6, and 17.5 months, respectively) to estimate health care system costs in 2024 United States dollars. Cost estimate inputs were based on a microcosting analysis of TRANSCEND FL AE data. The model assumed cost inputs of AE management would not differ across therapies. An analysis was performed using probabilistic distributions via Monte Carlo simulation methods to address uncertainty surrounding model inputs. AE rates (all grades) were assigned beta distributions. Cost inputs were assigned gamma distributions.
RESULTS: For liso-cel, axi-cel, and tisa-cel, respectively, mean costs (administration to AE resolution) were $1757, $3497, and $1570 for CRS; $358, $1964, and $623 for NEs; $6097, $10,579, and $4644 for prolonged cytopenia; and $3288, $7262, and $8756 for severe infections. Overall weighted average (95% CI) cost for these AEs was lowest for liso-cel at $11,499 ($11,262‒$11,737) versus $23,301 ($22,867‒$23,736) and $15,592 ($15,260‒$15,924) for axi-cel and tisa-cel, respectively.
CONCLUSIONS: The estimated total weighted average AE cost (CRS, NEs, prolonged cytopenia, serious infections) was 51% lower with liso-cel versus axi-cel and 26% lower versus tisa-cel, mostly owing to lower rates of prolonged cytopenia and serious infections with liso-cel. This highlights the economic importance of differentiated safety profiles between CAR T cell therapies for treatment of R/R FL.
METHODS: A decision tree economic model was developed using AE rates (by grade) from TRANSCEND FL, ELARA, and ZUMA-5 studies (median follow-up of 18.9, 16.6, and 17.5 months, respectively) to estimate health care system costs in 2024 United States dollars. Cost estimate inputs were based on a microcosting analysis of TRANSCEND FL AE data. The model assumed cost inputs of AE management would not differ across therapies. An analysis was performed using probabilistic distributions via Monte Carlo simulation methods to address uncertainty surrounding model inputs. AE rates (all grades) were assigned beta distributions. Cost inputs were assigned gamma distributions.
RESULTS: For liso-cel, axi-cel, and tisa-cel, respectively, mean costs (administration to AE resolution) were $1757, $3497, and $1570 for CRS; $358, $1964, and $623 for NEs; $6097, $10,579, and $4644 for prolonged cytopenia; and $3288, $7262, and $8756 for severe infections. Overall weighted average (95% CI) cost for these AEs was lowest for liso-cel at $11,499 ($11,262‒$11,737) versus $23,301 ($22,867‒$23,736) and $15,592 ($15,260‒$15,924) for axi-cel and tisa-cel, respectively.
CONCLUSIONS: The estimated total weighted average AE cost (CRS, NEs, prolonged cytopenia, serious infections) was 51% lower with liso-cel versus axi-cel and 26% lower versus tisa-cel, mostly owing to lower rates of prolonged cytopenia and serious infections with liso-cel. This highlights the economic importance of differentiated safety profiles between CAR T cell therapies for treatment of R/R FL.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE434
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology