INFORMING FUTURE FUNDING DECISIONS: A REAL-WORLD COST-EFFECTIVENESS ANALYSIS OF CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY FOR RELAPSED/REFRACTORY LARGE B-CELL LYMPHOMA
Author(s)
Lisa Masucci, MSc1, John Kuruvilla, MD2, Anca Prica, MD2, Pierre Villeneuve, MSc, PhD, MD3, Beate Sander, PhD4, Danielle Rodin, MD2, William WL Wong, PhD5, Kelvin Chan, MD6.
1University of Toronto, Toronto, ON, Canada, 2Princess Margaret Cancer Centre, Toronto, ON, Canada, 3University of Ottawa, Ottawa, ON, Canada, 4Toronto General Hospital, University Health Network, Toronto, ON, Canada, 5University of Waterloo, Kitchener, ON, Canada, 6Sunnybrook Health Sciences Centre, Richmond Hill, ON, Canada.
1University of Toronto, Toronto, ON, Canada, 2Princess Margaret Cancer Centre, Toronto, ON, Canada, 3University of Ottawa, Ottawa, ON, Canada, 4Toronto General Hospital, University Health Network, Toronto, ON, Canada, 5University of Waterloo, Kitchener, ON, Canada, 6Sunnybrook Health Sciences Centre, Richmond Hill, ON, Canada.
OBJECTIVES: CAR T-cell therapy has emerged as a practice changing treatment that improves survival for patients with relapsed/refractory large B-cell Lymphoma (LBCL). However, as one of the most expensive cancer therapies, its affordability remains uncertain. This study evaluated the real-world cost-effectiveness of CAR T-cell therapy compared with historical standard of care in patients with r/r LBCL who failed two or more lines of systemic therapy.
METHODS: We first conducted a retrospective analysis based on linked healthcare administrative data to obtain real-world survival and costs. These data informed a probabilistic state-transition (Markov) model developed from the perspective of a publicly funded healthcare system, to estimate costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) of each strategy over a life-time horizon. Survival estimates were derived from a real-world population-based study with a mean patient age of 57 years. Patients who remained progression free for five years, were assumed to be in long-term remission. Adverse events, utilities, and costs were obtained from the real-world analysis and secondary data sources. Costs and outcomes were discounted 1.5% annually, with costs reported in 2025 Canadian dollars. Deterministic one-way sensitivity analyses and scenario analyses were performed.
RESULTS: CAR T-cell therapy led to higher costs ($782,340 versus $309,305) and QALYs (5.41 versus 3.41), resulting in an ICER of $237,706/QALY compared to a historical standard of care. At a cost-effectiveness threshold of $100,000/QALY, CAR T-cell therapy was not cost-effective. One-way sensitivity analyses demonstrated that results were most sensitive to the cost of therapy and cohort age. If the cost of the therapy was reduced by 65%, CAR T-cell therapy would be cost-effective at a threshold of $100,000/QALY.
CONCLUSIONS: CAR T-cell therapy was not found to be cost-effective at the current price. These findings provide important real-world evidence to inform reassessments of CAR T-cell funding as reimbursement negotiations evolve.
METHODS: We first conducted a retrospective analysis based on linked healthcare administrative data to obtain real-world survival and costs. These data informed a probabilistic state-transition (Markov) model developed from the perspective of a publicly funded healthcare system, to estimate costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) of each strategy over a life-time horizon. Survival estimates were derived from a real-world population-based study with a mean patient age of 57 years. Patients who remained progression free for five years, were assumed to be in long-term remission. Adverse events, utilities, and costs were obtained from the real-world analysis and secondary data sources. Costs and outcomes were discounted 1.5% annually, with costs reported in 2025 Canadian dollars. Deterministic one-way sensitivity analyses and scenario analyses were performed.
RESULTS: CAR T-cell therapy led to higher costs ($782,340 versus $309,305) and QALYs (5.41 versus 3.41), resulting in an ICER of $237,706/QALY compared to a historical standard of care. At a cost-effectiveness threshold of $100,000/QALY, CAR T-cell therapy was not cost-effective. One-way sensitivity analyses demonstrated that results were most sensitive to the cost of therapy and cohort age. If the cost of the therapy was reduced by 65%, CAR T-cell therapy would be cost-effective at a threshold of $100,000/QALY.
CONCLUSIONS: CAR T-cell therapy was not found to be cost-effective at the current price. These findings provide important real-world evidence to inform reassessments of CAR T-cell funding as reimbursement negotiations evolve.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE691
Topic
Economic Evaluation
Disease
Oncology