OBJECTIVES: To estimate the cost-effectiveness of brexucabtagene autoleucel (BREXU-CEL) versus blinatumomab (BLIN), inotuzumab ozogamicin (INO), and salvage chemotherapy (CHEMO) for patients aged 26 years or older with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) from a United Kingdom (UK) National Health Service and Personal Social Services perspective.

METHODS: A three-health state partitioned-survival model comprising ‘event-free survival’ (EFS), ‘progressed disease’ and ‘death’ was used to estimate treatment-specific health outcomes and costs over a lifetime time horizon. Efficacy and safety data were from ZUMA-3 (Median follow-up 37.3 months) for BREXU-CEL, TOWER for BLIN, and INO-VATE for INO and CHEMO. Utility data were from ZUMA-3. Matching-adjusted indirect comparisons provided efficacy data for BREXU-CEL adjusted for differences between the ZUMA-3, TOWER, and INO-VATE study populations. Standard parametric models were used to extrapolate EFS and overall survival for all treatments. Patients alive at 3 years were assigned general population mortality to which a standardized mortality ratio of 1.09 was applied. Unit costs were obtained from public databases or literature. List prices were used for all treatments. Costs and health outcomes were discounted at 3.5% annually.

RESULTS: Compared with BLIN, INO, and CHEMO, BREXU-CEL resulted in 5.67, 4.93, and 6.25 life-years gained, and 4.29, 3.65, and 4.62 quality-adjusted life-years (QALYs) gained per patient, respectively. The incremental costs of BREXU-CEL versus BLIN, INO, and CHEMO were £94,433, £155,617, and £272,223, respectively. BREXU-CEL’s incremental cost-effectiveness ratios were £22,011/QALY versus BLIN, £42,623/QALY versus INO, and £58,897/QALY versus CHEMO. Results were robust to scenario analyses performed.

CONCLUSIONS: BREXU-CEL substantially improves the life-expectancy of patients with R/R B-ALL compared to BLIN, INO, and CHEMO and added life-years are spent in good health. Moreover, BREXU-CEL is cost-effective at list price versus BLIN and INO and borderline cost-effective versus CHEMO in the UK at a willingness-to-pay threshold of £50,000/QALY.