OBJECTIVES: In Ireland, health technology assessments (HTAs) are conducted by the National Centre for Pharmacoeconomics (NCPE) in line with national guidelines provided by the Health Information and Quality Authority. These guidelines dictate the parameters to be included when conducting an HTA. There have been steps toward homogenising HTA amongst European nations, for example EUnetHTA. However, efforts are hindered by differences between jurisdictions in the parameters included. CD19 CAR T-cell therapies are emerging modalities for the treatment of haematological B-cell cancers. The HTA of these therapies has proved challenging owing to a limited evidence base. The objective of this research was to perform a critical analysis of national HTAs of axicabtagene ciloleucel (Yescarta®), a CD19 CAR T-cell therapy – to identify similarities and differences between these and comment on the transferability of these national HTAs to the Irish setting.

METHODS: A qualitative analysis of national HTA reports pertaining to axicabtagene ciloleucel (Yescarta®) was conducted. Published reports written in a language other than English were excluded and only reports comprising a clinical and economic section were included, in line with Ireland’s national HTA guidelines. Parameters extracted were based on the NCPE assessment template and included both clinical and economic data.

RESULTS: A total of four reports were analysed. Common limitations in the clinical data and economic model were identified in all HTAs, the most notable of which was the limited evidence base. Major differences included the comparators, data cut-off date, extrapolation methods, jurisdiction-specific costs and discount rates. The overall HTA outcomes were different across all reviewed HTAs. Ireland’s national HTA guidelines were violated in all three assessments.

CONCLUSIONS: The identification of common limitations suggests scope for collaboration and dialogue between the various jurisdictions. However, the major differences identified and ultimately the different outcomes suggest that the HTAs are not transferable from jurisdiction to jurisdiction.