OBJECTIVES: For patients with diffuse large B-cell lymphoma (DLBCL), treatment options (interventions) are limited if their disease relapses or is refractory (r/r) to first-line therapy and they are ineligible for stem cell transplantation. Innovative interventions have been recently approved by the European Medicine Agency (tafasitamab-lenalidomide, Tafa-L; polatuzumab-bendamustine-rituximab, Pola-BR) for second-line (2L) treatment addressing this unmet medical need. Further interventions, e.g., CAR-T-cell therapies, are expected to be introduced for the 2L soon, albeit at rising treatment costs. Establishing a reimbursement according to the cost-effectiveness (CE) of an intervention (value-based pricing) is challenging for healthcare payers. In Germany, the efficiency frontier (EF) approach is recommended to evaluate the CE of interventions. Therefore, the objective was to investigate whether EFs can support healthcare payers´ pricing decisions for new interventions in the 2L treatment of transplant-ineligible r/r DLBCL.

METHODS: Following the Institute for Quality and Efficiency in Healthcare methodology, a systematic literature review was performed to determine clinical benefits concerning median overall survival (mOS) of the respective interventions. Varying mOS values were pooled by applying the bootstrap method. First-year treatment costs (drug and medical services costs) were calculated using publicly available databases. Treatment costs and mOS values were plotted on a two-dimensional graph creating an EF.

RESULTS: Currently, the interventions bendamustine-rituximab (BR) (mOS 11.49 months, €23,958) and Tafa-L (45.7 months, €104,541) form the EF, building the CE-threshold for new interventions. Rituximab-gemcitabine-oxaliplatin (R-GemOx) (13.27 months, €29,080) and Pola-BR (18.4 months, €96,200) are extendedly dominated by the incremental CE-ratio of BR and Tafa-L, hence not part of the EF.

CONCLUSIONS: EFs offer advantage of comparing all interventions in an indication area, according to the principle of value-based pricing. The most cost-effective intervention – here Tafa-L – can be identified, allowing the approach to serve as the basis for pricing decisions. However, the CE-threshold may move once new interventions are approved.