COST-EFFECTIVENESS OF AXICABTAGENE CILOLEUCEL VERSUS TISAGENLECLEUCEL FOR THIRD-LINE TREATMENT OF RELAPSED OR REFRACTORY LARGE B-CELL LYMPHOMA: ANALYSIS FROM THE PERSPECTIVE OF THE BRAZILIAN SUPPLEMENTARY HEALTHCARE SYSTEM
Author(s)
Vanderson Rocha, MD, PhD1, Carolina Padula, BA, MSc2, Enzo Waiti Asano, BS2, Jessika C. Bridi3, Cinthia Pereira Nakada, BA, MBA4.
1Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil, 2ORIGIN Health, São Paulo, Brazil, 3Gilead Sciences Farmaceutica do Brasil Ltda, São Paulo, Brazil, 4Gilead Sciences, São Paulo, Brazil.
1Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil, 2ORIGIN Health, São Paulo, Brazil, 3Gilead Sciences Farmaceutica do Brasil Ltda, São Paulo, Brazil, 4Gilead Sciences, São Paulo, Brazil.
OBJECTIVES: The emergence of chimeric antigen receptor T-cell (CAR T) therapy has revolutionized the management of relapsed or refractory large B-cell lymphoma (R/R LBCL). Currently, the Brazilian regulatory agency has approved two CAR T therapies for the management of R/R LBCL. This analysis evaluated the cost-utility of axicabtagene ciloleucel (axi-cel) versus tisagenlecleucel (tisa-cel) for the treatment of R/R LBCL after ≥2 lines of systemic therapy, from the perspective of the Brazilian Supplementary Healthcare System (SS).
METHODS: Cost-effectiveness was assessed using a partitioned survival model with three health states: progression-free, disease progression, and death. A lifetime horizon and monthly cycles were adopted. The base-case analysis employed mixture cure modeling, which assumed that a proportion of treated patients achieve long-term disease remission and potential cure. The time spent in each health state was used to estimate costs and quality-adjusted life years (QALYs). Efficacy data were obtained from a matching-adjusted indirect comparison, direct costs from official pricing sources, and health-state utility values from published literature. Costs were expressed in Brazilian reais (BRL). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the base-case results.
RESULTS: Axi-cel was associated with incremental gains of 2.55 life-years (7.94 vs. 5.38) and 2.30 QALYs (6.28 vs.3.98) compared to tisa-cel, at an incremental cost of BRL 272,215 (BRL 2,472,218 vs. BRL 2,200,002), generating an incremental cost-utility ratio of BRL 118,315 per QALY gained. Deterministic sensitivity analyses identified the main cost-effectiveness drivers, including variation in health-state utility values, survival extrapolation assumptions, and treatment-related costs. Cost-effectiveness acceptability curves demonstrated that 56.2% of simulations were considered cost-effective at a willingness-to-pay threshold of BRL 120,000 per QALY.
CONCLUSIONS: The results suggest that axi-cel may represent a cost-effective alternative for the management of R/R LBCL after failure of ≥2 prior lines of systemic therapy compared with tisa-cel, from the perspective of the Brazilian SS.
METHODS: Cost-effectiveness was assessed using a partitioned survival model with three health states: progression-free, disease progression, and death. A lifetime horizon and monthly cycles were adopted. The base-case analysis employed mixture cure modeling, which assumed that a proportion of treated patients achieve long-term disease remission and potential cure. The time spent in each health state was used to estimate costs and quality-adjusted life years (QALYs). Efficacy data were obtained from a matching-adjusted indirect comparison, direct costs from official pricing sources, and health-state utility values from published literature. Costs were expressed in Brazilian reais (BRL). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the base-case results.
RESULTS: Axi-cel was associated with incremental gains of 2.55 life-years (7.94 vs. 5.38) and 2.30 QALYs (6.28 vs.3.98) compared to tisa-cel, at an incremental cost of BRL 272,215 (BRL 2,472,218 vs. BRL 2,200,002), generating an incremental cost-utility ratio of BRL 118,315 per QALY gained. Deterministic sensitivity analyses identified the main cost-effectiveness drivers, including variation in health-state utility values, survival extrapolation assumptions, and treatment-related costs. Cost-effectiveness acceptability curves demonstrated that 56.2% of simulations were considered cost-effective at a willingness-to-pay threshold of BRL 120,000 per QALY.
CONCLUSIONS: The results suggest that axi-cel may represent a cost-effective alternative for the management of R/R LBCL after failure of ≥2 prior lines of systemic therapy compared with tisa-cel, from the perspective of the Brazilian SS.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE687
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology