REAL-WORLD COST-UTILITY ANALYSIS OF LISOCABTAGENE MARALEUCEL VERSUS AXICABTAGENE CILOLEUCEL AS SECOND-LINE THERAPY FOR RELAPSED OR REFRACTORY LARGE B-CELL LYMPHOMA IN FRANCE
Author(s)
Florian P. Colrat, MPH, PharmD1, Olfa Doghri, PharmD2, Romain Supiot, MSc2, FRANCOIS-EMERY COTTE, MA, MPH, PharmD, PhD3, Rahma Sellami, PharmD2, Sebastien Branchoux, MSc, PhD3.
1HEOR Manager, Bristol Myers Squibb, Rueil Malmaison, France, 2Putnam PHMR, Paris, France, 3Bristol Myers Squibb, Rueil Malmaison, France.
1HEOR Manager, Bristol Myers Squibb, Rueil Malmaison, France, 2Putnam PHMR, Paris, France, 3Bristol Myers Squibb, Rueil Malmaison, France.
OBJECTIVES: CAR-T cell therapies have transformed outcomes in second-line (2L) relapsed or refractory large B-cell lymphoma (R/R LBCL), yet head-to-head cost-utility evidence comparing lisocabtagene maraleucel (liso-cel) and axicabtagene ciloleucel (axi-cel) in real-world (RW) settings remains limited. This study evaluated the cost-utility of liso-cel versus axi-cel in 2L R/R LBCL in France, leveraging the largest RW comparative dataset available to date.
METHODS: A semi-Markov model with three health states (progression-free, post-progression, death) was developed over a 20-year horizon from the French collective perspective. Clinical inputs were derived from two DESCAR-T registry studies: Brisou et al. (head-to-head PFS and safety in balanced 2L populations, n=555) and Sesques et al. (post-CAR-T failure outcomes, n=297). Efficacy equivalence and better safety for liso-cel were modelled based on Brisou et al. PFS was modelled using a mixture-cure model with a Weibull distribution; post-progression survival with a log-logistic distribution. Utilities were derived from ZUMA-1 and ZUMA-7 trials using the French value set. Costs were sourced from French national databases and expressed in 2025 euros. Robustness was assessed through probabilistic sensitivity analysis (PSA, 1,000 Monte Carlo simulations).
RESULTS: At list prices, liso-cel was associated with lower total costs (€294,244 vs. €342,228; -€47,984) and higher QALYs (5.26 vs. 5.19; +0.07), thus dominating axi-cel. The cost difference was primarily driven by a lower acquisition cost (liso-cel: €199,059; axi-cel: €228,501) and lower administration costs during hospitalization (liso-cel: €56,454; axi-cel €73,916) reflecting liso-cel's more favorable safety profile. In the PSA, liso-cel remained less expensive in 100% of simulations and both less expensive and more effective in 68%. The probability of cost-effectiveness at €100,000/QALY was 100%.
CONCLUSIONS: With comparable efficacy, a more favorable safety profile and lower total costs, liso-cel is projected to be more cost-effective than axi-cel in 2L R/R LBCL in France. These results rely on the largest RW dataset available, while warranting longer-term confirmation.
METHODS: A semi-Markov model with three health states (progression-free, post-progression, death) was developed over a 20-year horizon from the French collective perspective. Clinical inputs were derived from two DESCAR-T registry studies: Brisou et al. (head-to-head PFS and safety in balanced 2L populations, n=555) and Sesques et al. (post-CAR-T failure outcomes, n=297). Efficacy equivalence and better safety for liso-cel were modelled based on Brisou et al. PFS was modelled using a mixture-cure model with a Weibull distribution; post-progression survival with a log-logistic distribution. Utilities were derived from ZUMA-1 and ZUMA-7 trials using the French value set. Costs were sourced from French national databases and expressed in 2025 euros. Robustness was assessed through probabilistic sensitivity analysis (PSA, 1,000 Monte Carlo simulations).
RESULTS: At list prices, liso-cel was associated with lower total costs (€294,244 vs. €342,228; -€47,984) and higher QALYs (5.26 vs. 5.19; +0.07), thus dominating axi-cel. The cost difference was primarily driven by a lower acquisition cost (liso-cel: €199,059; axi-cel: €228,501) and lower administration costs during hospitalization (liso-cel: €56,454; axi-cel €73,916) reflecting liso-cel's more favorable safety profile. In the PSA, liso-cel remained less expensive in 100% of simulations and both less expensive and more effective in 68%. The probability of cost-effectiveness at €100,000/QALY was 100%.
CONCLUSIONS: With comparable efficacy, a more favorable safety profile and lower total costs, liso-cel is projected to be more cost-effective than axi-cel in 2L R/R LBCL in France. These results rely on the largest RW dataset available, while warranting longer-term confirmation.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE682
Topic
Economic Evaluation, Real World Data & Information Systems
Disease
Genetic, Regenerative & Curative Therapies, Oncology