OBJECTIVES: To assess the value of axicabtagene ciloleucel (axi-cel) versus chemotherapy (CT) in the treatment of relapsed/refractory diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma after ≥2 lines of systemic therapy, in Spain.

METHODS: A partitioned survival mixture-cure model was used to estimate the lifetime life-years gained (LYG) and quality-adjusted life years (QALYs) with axi-cel and CT. Overall survival (OS) and progression-free survival (PFS) data were obtained from the ZUMA-1 trial for axi-cel (4-year follow-up) and the SCHOLAR-1 study for CT. Patients characteristics, utilities, and mortality were extracted from literature. In the base case, the incremental results of axi-cel versus CT were evaluated in a cohort of 183 patients, according to the cases treated in the “Spanish Plan to Tackle Advanced Therapies”. In an alternative scenario, the results were analysed in a cohort of 490 patients, according to epidemiological estimates for Spain.

RESULTS: In the base case (n=183), axi-cel versus CT would generate an increase of 162% in LYG (1,313 LYG) and a 165% in QALYs (1,030 QALYs). In the alternative scenario (n=490), the results could increase to 3,515 LYG and 2,759 QALYs with axi-cel versus CT. Consequently, treating with axi-cel versus CT the entire population eligible to receive axi-cel (n=490) compared to the currently treated population (n=183), would result in an increase of 2,202 LYG and 1,728 QALYs. Considering the modelled efficacy data, axi-cel versus CT would increase, at 5 years, the number of patients in PFS by 195% (n=47 in the base case and n=126 in the alternative scenario) and the number of surviving patients by 194% (n=51 in the base case and n=137 in the alternative scenario).

CONCLUSIONS: Since axi-cel would significantly improve health outcomes versus CT, it will be crucial to make efforts to increase the number of patients treated with axi-cel in Spain.