OBJECTIVES : DLBCL is the most common form of aggressive non-Hodgkin’s lymphoma (NHL) with 132 deaths per year estimated in SG. Unmet clinical need in R/R DLBCL is high: a recent retrospective study (Crump et al. 2017) showed median overall survival of 6.2 months in 636 patients with R/R DLBCL. This study aims to estimate the budget impact of adopting tisagenlecleucel in SG.

METHODS : A BIA was developed in which the current treatment pathway (without tisagenlecleucel) was compared to a future scenario (with tisagenlecleucel). Published sources and expert interviews were used to inform the R/R DLBCL treatment pathway, epidemiology (Globocan), grade 3 and above adverse event (AE) rates (Schuster 2019), cost and resource utilization. Costs included drug acquisition and administration, medical resource use, AE treatment, stem cell harvesting, pre work-up and surgery for haematopoietic stem-cell transplant (HSCT) and leukapheresis, lymphodepletion and bridging chemotherapy for tisagenlecleucel. Current treatments included salvage chemotherapy, assumed to be a combination of rituximab, gemcitabine, dexamethasone and cisplatin (R-GDP), with or without autologous HSCT and off-label treatments (lenalidomide and ibrutinib).

RESULTS : 56 (in 2020) increasing to 71 (in 2025) patients were estimated to be eligible for tisagenlecleucel under its R/R DLBCL expected indication (3^rd and later line DLBCL). Assuming market uptake increasing from 7.5% (2020) to 25% (2025), patients expected to be treated with tisagenlecleucel were 4 in 2020 increasing to 18 in 2025 with a net budget impact of S$1.5M in 2020 (+14%) to S$6.3M in 2025 (+45%).

CONCLUSIONS : The BIA suggests that the introduction of tisagenlecleucel in R/R DLBCL would cost SG between S$1.5M to S$6M per year compared to current spend; however, it is expected that outcomes from tisagenlecleucel would be considerably improved in patients whose life expectancies were measured by months or even weeks.