OBJECTIVES: Cost-effectiveness of axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) based on Phase II clinical trials, ZUMA-1 and JULIET respectively, has been previously explored (Oluwole et al, 2020). However, cost-effectiveness of these treatments based on the real-world setting remains limited. A recent real-world evidence (RWE) meta-analysis (Jacobson et al, 2023) evaluating progression-free survival (PFS), overall survival (OS), and adverse events, favored axi-cel for PFS (HR=0.67; 95%CI: 0.57-0.78) and OS (HR=0.60; 95%CI: 0.47-0.77) versus tisa-cel. Grade ≥3 cytokine release syndrome was comparable between treatments; Grade ≥3 neurotoxicity was higher for axi-cel. The objective of this study was to assess the cost-effectiveness of axi-cel and tisa-cel, utilizing RWE, in relapsed/refractory (R/R) large B-cell lymphoma (LBCL) after ≥2 prior systemic therapies (3L+).

METHODS: A partitioned survival model was developed to deduce the real-world costs and survival in R/R 3L+ LBCL. Patients initiated the model in the PFS state, transitioning to progressed disease and death states based on PFS and OS curves, respectively. Survival estimates were generated using pseudo patient-level data derived from RWE and extrapolated over a full lifetime using mixture-cure parametric models. Utilities were derived from ZUMA-1. Costs were sourced from US databases and relevant literature. Costs and outcomes were discounted at an annual rate of 3%.

RESULTS: Compared with tisa-cel, axi-cel resulted in an incremental cost-effectiveness ratio (ICER) of $18,136; Incremental quality-adjusted life years (QALYs) and costs were 1.16 and $21,003, respectively. Probabilistic sensitivity analysis demonstrated that the ICER remained ≤$94,000 in 99% of simulations, which is below the often cited cost-effectiveness threshold of $150,000/QALY.

CONCLUSIONS: With the incorporation of emerging RWE in 3L+ LBCL, axi-cel is cost-effective compared to tisa-cel, from a US payer’s perspective. Further, this study reinforces previously generated results from clinical trials, thus bolstering confidence in the cost-effectiveness of axi-cel vs tisa-cel in current clinical practice.