OBJECTIVES: To estimate the cost-effectiveness of axicabtagene ciloleucel (axi-cel) as 4^th or later line (4L+) treatment for relapsed or refractory follicular lymphoma (r/r FL) versus a market basket standard of care (SoC), from a healthcare perspective in Sweden.

METHODS: A three-health state partitioned-survival model was used to estimate expected lifetime costs, life-years (LYs) and quality-adjusted life-years (QALYs) discounted at 3% annually. Progression-free survival (PFS) and overall survival (OS) was estimated using the 36-month follow-up, intention-to-treat population from the ZUMA-5 trial (axi-cel) and propensity score weighted data from the SCHOLAR-5 cohort study (SoC) as a synthetic control arm. Extrapolations of PFS and OS used piecewise cure modelling assuming a 40% cure fraction after five years (axi-cel), and standard parametric models (SoC). Utility values were obtained from a UK study of r/r FL patients who had received 2^nd line treatment. Medical resource use and 2022-year unit costs in Swedish Kronor (SEK) were obtained from the literature and Swedish price lists. Sensitivity analyses were conducted to assess robustness of the results.

RESULTS: Patients receiving axi-cel had incremental discounted LYs and QALYs of 6.00 and 4.87 respectively compared to SoC and total incremental costs of SEK 3,310,856, resulting in an incremental cost-effectiveness ratio (ICER) of SEK 680,001 per QALY gained. The ICER was most sensitive to mean patient age, progression-free utility, piecewise cure fraction, choice of parametric distribution for OS and shorter time horizons. The likelihood of axi-cel being cost-effective compared to SoC was 99% at the relevant willingness-to-pay threshold for r/r FL (1 million SEK).

CONCLUSIONS: Axi-cel is a cost-effective 4L+ treatment alternative to SoC for adults with r/r FL in Sweden. Cost-effectiveness results were similar to a previous axi-cel indication assessed by the Swedish HTA agency (3^rd line treatment for diffuse large B-cell lymphoma: company base case ICER of SEK 657,112/QALY gained).