OBJECTIVES:

In the UK, it is estimated that approximately 5,076 patients will be newly diagnosed for DLBCL in 2022, with an annual incidence rate of 7.72 per 100,000. The total number of patients eligible for CAR T-cell therapy at 3rd line and beyond in 2022 is estimated to be 538. Axicabtagene ciloleucel (axi-cel; a chimeric antigen receptor [CAR T]-cell therapy) was evaluated in ZUMA-1 (a single-arm phase II trial in patients with relapsed or refractory [r/r] DLBCL). Responses were durable, and median overall survival was 25.8 months and the 5-year OS rate was 43%. This analysis used a UK healthcare system perspective to assess the cost-effectiveness of axi-cel versus other CAR T-cell therapies (tisagenlecleucel [tisa-cel] and lisocabtagene maraleucel [liso-cel]) in the treatment of r/r DLBCL.

METHODS:

Costs and quality-adjusted life years (QALYs) were extrapolated over a lifetime time horizon using a partitioned survival model. Matching-adjusted indirect comparisons were conducted to reweight the ZUMA-1 patient population to better reflect the populations in each of JULIET (tisa-cel) and TRANSCEND (liso-cel) trials. Independent mixture cure models fitted to the JULIET, TRANSCEND, and reweighted ZUMA-1 data were used to generate survival curves for progression-free survival and overall survival. Costs and outcomes were discounted at an annual rate of 3.5%. Costs were obtained from UK registries and published sources, and utility values were derived from ZUMA-1. List prices were assumed for axi-cel and tisa-cel. Since the list price for Liso-cel was not available (at the time of submission) the same price as tisa-cel was used.

RESULTS:

Axi-cel is associated with an incremental cost-effectiveness ratio of £1,223 compared with liso-cel and is dominant compared to tisa-cel; incremental QALYs are 1.88 and 2.27, respectively.

CONCLUSIONS:

Axi-cel is expected to represent a cost-effective use of UK healthcare resources compared with other CAR T-cell therapies.