COST-EFFECTIVENESS OF IBRUTINIB-BASED INDUCTION WITH OR WITHOUT AUTOLOGOUS STEM CELL TRANSPLANTATION IN NEWLY DIAGNOSED MANTLE CELL LYMPHOMA: A LIFETIME MARKOV MODEL BASED ON THE TRIANGLE TRIAL
Author(s)
Mahmood AminiLari, PhD1, Petros Pechlivanoglou, MSc, PhD2, Erwen Wu, MSc2, Inna Gong, MD3, David Hodgson, MD1, John Kuruvilla, MD3, Abi Vijenthira, BSc, MD3, Anca Prica, MD3.
1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 2The Hospital for Sick Children, Toronto, ON, Canada, 3Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 2The Hospital for Sick Children, Toronto, ON, Canada, 3Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
OBJECTIVES: The TRIANGLE trial demonstrated improved outcomes with first-line ibrutinib in mantle cell lymphoma (MCL), whereas adding autologous stem cell transplantation (ASCT) to an ibrutinib-containing regimen did not improve outcomes. However, the economic value of ibrutinib and ASCT remains uncertain. We evaluated the lifetime cost-effectiveness of standard chemoimmunotherapy plus ASCT (Group A), ibrutinib plus chemoimmunotherapy without ASCT(Group I), and ibrutinib plus chemoimmunotherapy plus ASCT(Group A+I) from the Canadian public-payer perspective.
METHODS: We developed a four-state Markov model (progression-free, progressed, second progression, and death) with tunnel states over a lifetime horizon. First-line survival outcomes were derived from parametric models fitted to digitized TRIANGLE Kaplan-Meier curves. We evaluated multiple combinations of calibrated distributions, and selected the final models based on calibration likelihood and agreement with observed trial outcomes. Second-line outcomes were informed by published studies in relapsed/refractory MCL and modeled using zanubrutinib-based inputs across all treatment arms. Costs and outcomes were discounted at 1.5% annually. Lifetime costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. Uncertainty was assessed using probabilistic sensitivity analysis (500 simulations).
RESULTS: In the base case, Group A generated 13.40 QALYs and 22.79 LYs at a mean cost of CAD $468,260. Compared with Group A, Group I gained 2.34 QALYs and 3.30LYs at an incremental cost of CAD $107,621 (ICER=CAD $46,049/QALY). Group A+I yielded comparable health outcomes but at a higher cost (CAD $594,941) and was dominated by Group I. Probabilistic sensitivity analysis showed that Group I had the highest probability of being cost-effective at willingness-to-pay thresholds above approximately CAD $50,000/QALY and above.
CONCLUSIONS: Ibrutinib plus chemoimmunotherapy without ASCT was cost-effective compared with standard chemoimmunotherapy plus ASCT. Adding ASCT to an ibrutinib-based strategy increased costs without improving projected outcomes and was not cost-effective based on available evidence. Decisions regarding ASCT should remain individualized based on patient characteristics.
METHODS: We developed a four-state Markov model (progression-free, progressed, second progression, and death) with tunnel states over a lifetime horizon. First-line survival outcomes were derived from parametric models fitted to digitized TRIANGLE Kaplan-Meier curves. We evaluated multiple combinations of calibrated distributions, and selected the final models based on calibration likelihood and agreement with observed trial outcomes. Second-line outcomes were informed by published studies in relapsed/refractory MCL and modeled using zanubrutinib-based inputs across all treatment arms. Costs and outcomes were discounted at 1.5% annually. Lifetime costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. Uncertainty was assessed using probabilistic sensitivity analysis (500 simulations).
RESULTS: In the base case, Group A generated 13.40 QALYs and 22.79 LYs at a mean cost of CAD $468,260. Compared with Group A, Group I gained 2.34 QALYs and 3.30LYs at an incremental cost of CAD $107,621 (ICER=CAD $46,049/QALY). Group A+I yielded comparable health outcomes but at a higher cost (CAD $594,941) and was dominated by Group I. Probabilistic sensitivity analysis showed that Group I had the highest probability of being cost-effective at willingness-to-pay thresholds above approximately CAD $50,000/QALY and above.
CONCLUSIONS: Ibrutinib plus chemoimmunotherapy without ASCT was cost-effective compared with standard chemoimmunotherapy plus ASCT. Adding ASCT to an ibrutinib-based strategy increased costs without improving projected outcomes and was not cost-effective based on available evidence. Decisions regarding ASCT should remain individualized based on patient characteristics.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO208
Topic
Clinical Outcomes, Economic Evaluation
Disease
Oncology