Presentation (CTI)

OBJECTIVES: In South Korea, tisagenlecleucel (tisa-cel) is reimbursed as third-line (3L) therapy for relapsed/refractory large B-cell lymphoma (r/r LBCL), whereas axicabtagene ciloleucel (axi-cel) has been proposed for second-line (2L) use. This study evaluated the cost-effectiveness of early CAR-T therapy (2L axi-cel) compared with delayed CAR-T therapy (2L standard of care [SoC] followed by 3L tisa-cel) from the Korean healthcare payer perspective.
METHODS: A state-transition model was developed to compare early and delayed CAR-T strategies in patients with r/r LBCL over a lifetime horizon with monthly cycles. Clinical efficacy inputs were derived from reconstructed individual patient data from the ZUMA-7 and JULIET trials. Parametric survival models were fitted to estimate long-term outcomes. Direct medical costs were obtained from Korean reimbursement sources and published literature. Health outcomes were measured in quality-adjusted life-years (QALYs). Costs and outcomes were discounted at 4.5% annually. One-way sensitivity analyses were performed to assess parameter uncertainty.
RESULTS: Early CAR-T therapy generated 6.45 QALYs at a lifetime cost of KRW 414.2 million, compared with 4.81 QALYs and KRW 219.8 million for delayed CAR-T therapy. The incremental gain was 1.64 QALYs with an additional cost of KRW 194.4 million, resulting in an incremental cost-effectiveness ratio (ICER) of KRW 118.7 million per QALY gained. Sensitivity analyses identified axi-cel acquisition cost as the most influential parameter, followed by the probability of receiving 3L tisa-cel after 2L SoC failure and the probability of receiving 2L axi-cel. Health state utilities and end-of-life costs had relatively little impact on the ICER.
CONCLUSIONS: Early CAR-T strategy provided greater health benefits but was associated with higher costs. The cost-effectiveness of the early CAR-T strategy was highly sensitive to CAR-T acquisition costs and treatment access patterns, highlighting the importance of pricing and reimbursement policies for earlier CAR-T use in Korea.