EVALUATING THE ECONOMIC IMPACT OF EARLIER CAR T USE IN RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA: A 24-MONTH COST SEQUENCING ANALYSIS FROM THE BRAZILIAN PRIVATE HEALTHCARE PERSPECTIVE
Author(s)
Samir Nabhan, MD1, Gabriel Leonel Marasco, BA and Postgraduate2, Cinthia Pereira Nakada, BA, MBA3, Jessika C. Bridi, BA, PhD3.
1Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil, 2ORIGIN Health, Santo André, Brazil, 3Gilead Sciences, São Paulo, Brazil.
1Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil, 2ORIGIN Health, Santo André, Brazil, 3Gilead Sciences, São Paulo, Brazil.
OBJECTIVES: Treatment sequencing is a key determinant of clinical and economic outcomes in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), particularly in healthcare systems with shorter payer planning horizons. This study evaluated the economic impact of alternative sequencing strategies for axicabtagene ciloleucel (axi-cel) in R/R DLBCL over 24-month from the Brazilian private healthcare perspective.
METHODS: A deterministic weighted treatment cost sequencing model compared cumulative treatment costs across various DLBCL sequencing strategies in which axi-cel was considered in second-line (2L), third-line (3L), and fourth-line (4L) settings. The 24-month time horizon reflected the average beneficiary retention observed in the Brazilian private healthcare system. Treatment sequencing assumptions, progression probabilities, and event-free survival estimates were based on pivotal clinical trials. Only drug acquisition costs were considered, using the Câmara de Regulação do Mercado de Medicamentos (CMED) April 2026 price list and CMED ex-factory prices including 18% VAT. Costs were reported in Brazilian Reais (BRL).
RESULTS: Earlier use of axi-cel was associated with lower cumulative treatment costs over 24 months. Total weighted average sequence costs per patient were BRL 791,111 for the 2L CAR-T scenario, BRL 794,315 for the 3L CAR T scenario, and BRL 901,353 for the 4L CAR T scenario. Earlier sequencing reduced the proportion of patients requiring subsequent lines of therapy within the modeled horizon, leading to lower downstream treatment exposure and reduced cumulative costs. Compared with CAR T use in 4L, use in 2L resulted in a 12% reduction in total treatment costs.
CONCLUSIONS: From the Brazilian private healthcare perspective, earlier sequencing of axi-cel in R/R DLBCL is associated with lower cumulative treatment costs over a 24-month horizon. Reduced need for subsequent therapies is a key driver of the economic benefit. These findings provide payer-relevant evidence to support the evaluation of earlier CAR T within operationally relevant decision-making horizons.
METHODS: A deterministic weighted treatment cost sequencing model compared cumulative treatment costs across various DLBCL sequencing strategies in which axi-cel was considered in second-line (2L), third-line (3L), and fourth-line (4L) settings. The 24-month time horizon reflected the average beneficiary retention observed in the Brazilian private healthcare system. Treatment sequencing assumptions, progression probabilities, and event-free survival estimates were based on pivotal clinical trials. Only drug acquisition costs were considered, using the Câmara de Regulação do Mercado de Medicamentos (CMED) April 2026 price list and CMED ex-factory prices including 18% VAT. Costs were reported in Brazilian Reais (BRL).
RESULTS: Earlier use of axi-cel was associated with lower cumulative treatment costs over 24 months. Total weighted average sequence costs per patient were BRL 791,111 for the 2L CAR-T scenario, BRL 794,315 for the 3L CAR T scenario, and BRL 901,353 for the 4L CAR T scenario. Earlier sequencing reduced the proportion of patients requiring subsequent lines of therapy within the modeled horizon, leading to lower downstream treatment exposure and reduced cumulative costs. Compared with CAR T use in 4L, use in 2L resulted in a 12% reduction in total treatment costs.
CONCLUSIONS: From the Brazilian private healthcare perspective, earlier sequencing of axi-cel in R/R DLBCL is associated with lower cumulative treatment costs over a 24-month horizon. Reduced need for subsequent therapies is a key driver of the economic benefit. These findings provide payer-relevant evidence to support the evaluation of earlier CAR T within operationally relevant decision-making horizons.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE80
Topic
Economic Evaluation, Health Technology Assessment, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology