Cost-effectiveness of Chimeric Antigen Receptor (CAR) T-cell Therapy for Relapsed or Refractory Large B-cell Lymphoma (r/r LBCL): A Systematic Review and Meta-Analysis
Author(s)
Taylor J. Loftus, BS1, Jeong-Yeon Cho, PharmD, PhD1, Manuel Meraz, BS1, Teerapon Dhippayom, PharmD, PhD2, Allison Bock, MD3, Charlotte Wagner, PharmD3, Kednapa Thavorn, PhD4, Nathorn Chaiyakunapruk, PharmD, PhD1.
1University of Utah College of Pharmacy, Salt Lake City, UT, USA, 2Naresuan University, Tha Pho, Thailand, 3Huntsman Cancer Institute, Salt Lake City, UT, USA, 4Ottawa Hospital Research Institute, Ottawa, ON, Canada.
1University of Utah College of Pharmacy, Salt Lake City, UT, USA, 2Naresuan University, Tha Pho, Thailand, 3Huntsman Cancer Institute, Salt Lake City, UT, USA, 4Ottawa Hospital Research Institute, Ottawa, ON, Canada.
OBJECTIVES: Cost-effectiveness evidence of Chimeric Antigen Receptor (CAR) T-cell therapies for treatment of relapsed or refractory large B-cell lymphoma (r/r LBCL) remains controversial given the high cost of therapy. This study aims to synthesize cost-effectiveness data on CAR T-cell therapy for treating r/r LBCL in adults using meta-analysis
METHODS: Cost-effectiveness analyses of CAR T-cell therapies for the treatment of r/r LBCL from inception through November 2024 were identified through database searches (MEDLINE, EMBASE, and CENTRAL). Costs were converted to 2023 US dollars using purchasing power parity. Incremental Net Benefit (INB) was calculated by multiplying incremental effectiveness by the willingness-to-pay threshold and subtracting the incremental costs. INB data, with 95% confidence intervals (95%CI), were pooled using a random-effects model. Results were stratified by country income level and perspective. The risk of bias was evaluated using ECOBIAS.
RESULTS: Thirty-two studies were included in this systematic review. Ten comparisons evaluated CAR T-cell therapies against second-line standard of care (SOC) treatments for LBCL, while nine comparisons evaluated CAR T-cell therapies against third-line SOC treatments. For high-income countries (N=15), CAR T-cell therapies were cost-effective as second-line therapy versus SOC (INB: $64,071; 95%CI: -$23,575 to $151,718, N=8) but not cost-effective as third-line therapy (INB: -$63,749; 95%CI: -$191,013 to $63,515, N=7). For non-high-income countries (N=4), CAR T-cell therapies were not cost-effective as either second-line (INB: -$36,608; 95%CI: -$86,618 to $13,402, N=2) or third-line therapy versus SOC (INB: -$116,208; 95%CI: -$214,785 to -$17,632, N=2). These results were robust under a series of sensitivity analyses.
CONCLUSIONS: Our finding suggests that CAR T-cell therapy may be cost-effective as second-line treatment for LBCL in high-income countries, but not cost-effective as second-line treatment in non-high-income countries nor as third-line treatment for LBCL regardless of country income level. These findings can provide valuable insights for decision-makers regarding coverage of CAR T-cell therapies for r/r LBLC.
METHODS: Cost-effectiveness analyses of CAR T-cell therapies for the treatment of r/r LBCL from inception through November 2024 were identified through database searches (MEDLINE, EMBASE, and CENTRAL). Costs were converted to 2023 US dollars using purchasing power parity. Incremental Net Benefit (INB) was calculated by multiplying incremental effectiveness by the willingness-to-pay threshold and subtracting the incremental costs. INB data, with 95% confidence intervals (95%CI), were pooled using a random-effects model. Results were stratified by country income level and perspective. The risk of bias was evaluated using ECOBIAS.
RESULTS: Thirty-two studies were included in this systematic review. Ten comparisons evaluated CAR T-cell therapies against second-line standard of care (SOC) treatments for LBCL, while nine comparisons evaluated CAR T-cell therapies against third-line SOC treatments. For high-income countries (N=15), CAR T-cell therapies were cost-effective as second-line therapy versus SOC (INB: $64,071; 95%CI: -$23,575 to $151,718, N=8) but not cost-effective as third-line therapy (INB: -$63,749; 95%CI: -$191,013 to $63,515, N=7). For non-high-income countries (N=4), CAR T-cell therapies were not cost-effective as either second-line (INB: -$36,608; 95%CI: -$86,618 to $13,402, N=2) or third-line therapy versus SOC (INB: -$116,208; 95%CI: -$214,785 to -$17,632, N=2). These results were robust under a series of sensitivity analyses.
CONCLUSIONS: Our finding suggests that CAR T-cell therapy may be cost-effective as second-line treatment for LBCL in high-income countries, but not cost-effective as second-line treatment in non-high-income countries nor as third-line treatment for LBCL regardless of country income level. These findings can provide valuable insights for decision-makers regarding coverage of CAR T-cell therapies for r/r LBLC.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
SA80
Topic
Study Approaches
Topic Subcategory
Meta-Analysis & Indirect Comparisons
Disease
SDC: Oncology