Presentation (CTI)

OBJECTIVES: To evaluate the cost-effectiveness of axicabtagene ciloleucel (Axi-cel) versus standard care (SC) in second-line treatment for diffuse large B-cell lymphoma (DLBCL) from the perspectives of the Chinese health system and the whole society.
METHODS: Based on the clinical trial data of ZUMA-7, a partitioned survival model was employed to evaluate cost-effectiveness over a lifetime horizon. Cost inputs were derived from public documents and literature. From the health system perspective, only direct medical costs were included, while the societal perspective incorporated both direct and indirect medical costs (i.e., productivity losses). Costs and QALYs were discounted at 5% annually. One-way and probabilistic sensitivity analysis (PSA) were conducted to assess the robustness of the base-case results.
RESULTS: From the health system perspective, Axi-cel resulted in 1.54 QALYs gained and an additional cost of RMB 436,078.05 compared to SC and the incremental cost-effectiveness ratio (ICER) of the Axi-cel group was RMB 283,093.74 per QALY, which exceeded the threshold of RMB 268,074 per QALY (three times China’s GDP in 2023). PSA results indicated that Axi-cel was cost-effective in 39% of 1,000 simulations. From the societal perspective, Axi-cel yielded 1.54 incremental QALYs, an additional cost of RMB 350,391.05, and an ICER of RMB 227,467.34 per QALY, below the threshold. PSA results showed Axi-cel to be cost-effective in 73% of simulations.
CONCLUSIONS: From the Chinese health system perspective, Axi-cel is not cost-effective as second-line therapy for DLBCL. While considering the productivity value of gene therapy drugs, from the societal perspective, the economic evaluation of Axi-cel has shown a positive result. The result suggests that access to innovative high-value medicine, represented by gene therapies, should consider a broader range of value dimensions.