IMPACT OF CAPACITY CONSTRAINTS ON THE COST-EFFECTIVENESS OF SECOND-LINE CAR T-CELL THERAPY FOR DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL)
Author(s)
Jacqueline A. May, PhD1, Emanuel Krebs, MA2, Reka Pataky, PhD2, Maryann Rogers, MPH1, Deirdre Weymann, MA2, Dean Regier, BA, MA, PhD1.
1School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, 2Regulatory Science Lab, BC Cancer Research Institute, Vancouver, BC, Canada.
1School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, 2Regulatory Science Lab, BC Cancer Research Institute, Vancouver, BC, Canada.
OBJECTIVES: DLBCL is the most common subtype of non-Hodgkin lymphoma and one of the most common cancers. Clinical practice guidelines now recommend use of CAR T-cell therapy earlier in the treatment pathway. We determined the cost-effectiveness of second-line CAR T-cell therapy versus standard care in Canada, incorporating varying wait times arising from manufacturing and delivery capacity constraints, essential for assessing health system value and for informing implementation decisions.
METHODS: We constructed and validated a discrete event microsimulation model capturing second-line and third-line pre-infusion wait times, progression-free disease, progressed disease, remission, and death. We parameterized the model using literature-based inputs, including survival data, adverse event probabilities, costs, and utilities. Baseline wait time was 1 month. Primary outcomes were incremental costs (2025 CAD), quality-adjusted life years (QALYs) (healthcare payer perspective; lifetime horizon), incremental cost-effectiveness ratio (ICER) and value-based price (VBP) at a willingness-to-pay threshold (WTP) of $100,000/QALY. In scenario analysis, we assessed wait time impacts of increasing patient volumes, time-homogeneous and random patient arrival rates, and health system capacity constraints.
RESULTS: Compared to standard care, CAR T led to increased costs ($321,766; 95%CI: $233,795-$413,801) and increased QALYs (1.58; 0.95-2.11), generating an ICER of $211,148 ($131,333-$362,290)/QALY. At $100,000/QALY WTP, CAR T had a 0.0% probability of being cost-effective. The estimated VBP was $247,350, a 49% reduction compared to market price. When wait times reached 2 months due to 50% increase in patient volume, the VBP decreased to $184,300. When capacity constraints increased wait times up to 3 months, CAR T had lower effectiveness compared to standard care.
CONCLUSIONS: CAR T was not found to be a cost-effective second-line option at current prices, with increased wait times reducing comparative effectiveness. Accounting for capacity constraint impacts provides practical insights for the implementation of specialized immunotherapy treatments like CAR T into real-world clinical care pathways.
METHODS: We constructed and validated a discrete event microsimulation model capturing second-line and third-line pre-infusion wait times, progression-free disease, progressed disease, remission, and death. We parameterized the model using literature-based inputs, including survival data, adverse event probabilities, costs, and utilities. Baseline wait time was 1 month. Primary outcomes were incremental costs (2025 CAD), quality-adjusted life years (QALYs) (healthcare payer perspective; lifetime horizon), incremental cost-effectiveness ratio (ICER) and value-based price (VBP) at a willingness-to-pay threshold (WTP) of $100,000/QALY. In scenario analysis, we assessed wait time impacts of increasing patient volumes, time-homogeneous and random patient arrival rates, and health system capacity constraints.
RESULTS: Compared to standard care, CAR T led to increased costs ($321,766; 95%CI: $233,795-$413,801) and increased QALYs (1.58; 0.95-2.11), generating an ICER of $211,148 ($131,333-$362,290)/QALY. At $100,000/QALY WTP, CAR T had a 0.0% probability of being cost-effective. The estimated VBP was $247,350, a 49% reduction compared to market price. When wait times reached 2 months due to 50% increase in patient volume, the VBP decreased to $184,300. When capacity constraints increased wait times up to 3 months, CAR T had lower effectiveness compared to standard care.
CONCLUSIONS: CAR T was not found to be a cost-effective second-line option at current prices, with increased wait times reducing comparative effectiveness. Accounting for capacity constraint impacts provides practical insights for the implementation of specialized immunotherapy treatments like CAR T into real-world clinical care pathways.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE79
Topic
Economic Evaluation, Health Policy & Regulatory, Health Service Delivery & Process of Care
Disease
Genetic, Regenerative & Curative Therapies, Oncology, Personalized & Precision Medicine