CAR-NK Cell Therapy for Ovarian Cancer Treatment in the First Relapse: Assessing Conditions Needed for Cost-Effectiveness in the Netherlands Using Early Health-Economic Modeling
Author(s)
Abril Seyahian, PhD1, Mirre Scholte, PhD2, Chantal Gravesteijn, Drs3, Petronella Beatrix Ottevanger, PhD4, Petra L. M. Zusterzeel, PhD5, Ruud L. M. Bekkers, PhD6, Harry Dolstra, PhD3, Janneke Grutters, MSc, PhD1.
1Science Department IQ Health, Radboud University Medical Center, Nijmegen, Netherlands, 2Science Department IQ Health ; Department of Radiology, Radboud University Medical Center, Nijmegen, Netherlands, 3Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands, 4Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands, 5Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands, 6GROW school for oncology and reproduction; Maastricht University, Department of Obstetrics and Gynecology, Radboud University Medical Center; Department of Obstetrics and Gynecology, Catharina Hospital, Nijmegen; Eindhoven; Maastricht, Netherlands.
1Science Department IQ Health, Radboud University Medical Center, Nijmegen, Netherlands, 2Science Department IQ Health ; Department of Radiology, Radboud University Medical Center, Nijmegen, Netherlands, 3Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands, 4Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands, 5Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands, 6GROW school for oncology and reproduction; Maastricht University, Department of Obstetrics and Gynecology, Radboud University Medical Center; Department of Obstetrics and Gynecology, Catharina Hospital, Nijmegen; Eindhoven; Maastricht, Netherlands.
OBJECTIVES: Relapsed ovarian cancer (OC) is a highly fatal disease. In the Netherlands, 5-year survival for patients diagnosed with advanced OC ranges between 14 and 29%. Preclinical evidence has shown that OC is susceptible to Natural Killer (NK) cell attack. This study developed an early health economic model to explore under which conditions NK cell therapy, genetically modified with chimeric antigen receptors (CAR), could be cost-effective when added to standard of care (SoC) for platinum-sensitive OC in first relapse.
METHODS: A partitioned survival model with three health states (progression free survival, relapsed disease and death) was built in Microsoft Excel. The model uses 3-weeks cycles and a lifetime horizon, and compares SoC versus SoC plus CAR-NK cell therapy from a Dutch healthcare perspective. Costs of the CAR-NK cell therapy were estimated using bottom-up costing. Due to uncertainty, two cost scenarios for CAR-NK cell therapy were considered: €45,000 and €60,000 per patient per treatment. Other costs, clinical, safety and quality of life inputs were based on literature. Resource use was based on expert opinion. Costs and outcomes were discounted at a 3% and 1.5% annual rate respectively. All costs are expressed in 2023 Euros (€). Scenario, threshold and multivariate sensitivity analyses were used to explore conditions that would need to be met for CAR-NK cell therapy to be cost-effective.
RESULTS: At a cost-effectiveness threshold of €80,000/QALY, patients would need to gain 0.76 QALYs (1 life year) to be cost-effective at €45,000. At €60,000, a gain of 0.95 QALYs (1.25 life years) would be required. Results are highly sensitive to changes in utility values, life years gained, and therapy costs.
CONCLUSIONS: Based on our early modelling, CAR-NK Cell therapy has the potential to become a cost-effective treatment in relapsed OC patients. However, benefits needed are quite high, which makes further cost and upscaling optimization essential.
METHODS: A partitioned survival model with three health states (progression free survival, relapsed disease and death) was built in Microsoft Excel. The model uses 3-weeks cycles and a lifetime horizon, and compares SoC versus SoC plus CAR-NK cell therapy from a Dutch healthcare perspective. Costs of the CAR-NK cell therapy were estimated using bottom-up costing. Due to uncertainty, two cost scenarios for CAR-NK cell therapy were considered: €45,000 and €60,000 per patient per treatment. Other costs, clinical, safety and quality of life inputs were based on literature. Resource use was based on expert opinion. Costs and outcomes were discounted at a 3% and 1.5% annual rate respectively. All costs are expressed in 2023 Euros (€). Scenario, threshold and multivariate sensitivity analyses were used to explore conditions that would need to be met for CAR-NK cell therapy to be cost-effective.
RESULTS: At a cost-effectiveness threshold of €80,000/QALY, patients would need to gain 0.76 QALYs (1 life year) to be cost-effective at €45,000. At €60,000, a gain of 0.95 QALYs (1.25 life years) would be required. Results are highly sensitive to changes in utility values, life years gained, and therapy costs.
CONCLUSIONS: Based on our early modelling, CAR-NK Cell therapy has the potential to become a cost-effective treatment in relapsed OC patients. However, benefits needed are quite high, which makes further cost and upscaling optimization essential.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE122
Topic
Economic Evaluation
Disease
Oncology