OBJECTIVES: Tafasitamab is indicated in combination with lenalidomide followed by tafasitamab monotherapy for the treatment of adult patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who are not eligible for autologous stem cell transplant (ASCT). We sought to evaluate the cost-effectiveness of tafasitamab and lenalidomide combination followed by tafasitamab monotherapy versus polatuzumab vedotin, bendamustine and rituximab (Pola-BR), tisagenlecleucel, and rituximab, gemcitabine and oxaliplatin (R-GemOx) from a Greek third-party payer perspective.

METHODS: A partitioned survival model with three health states (progression-free survival, progressive disease, and death), with a lifetime horizon, and 3.5% annual discount rate (costs and benefits) was developed. The efficacy inputs for tafasitamab and lenalidomide - including PFS, overall survival, and treatment discontinuation - were taken from the L-MIND study with efficacy data for comparators generated from the Re-MIND 2 study. Costs and utilities were derived from public sources and the international literature. The primary outcome of the analysis was the incremental cost per quality-adjusted life year (QALY) gained. Secondary outcomes were life years (LYs) and QALYs gained, incremental costs, and incremental cost per LY gained. Sensitivity analyses were conducted to assess the robustness of the results.

RESULTS: Patients receiving the tafasitamab and lenalidomide combination followed by tafasitamab monotherapy gained more QALYs and LYs. Total incremental QALYs range from 3.10 (versus R GemOx) to 3.59 (versus Pola-BR). Ιncremental cost effectiveness ratios (ICERs) varied from €17,527 per QALY gained (versus Pola-BR) to €38,637 per QALY gained (versus R-GemOx). When compared with tisagenlecleucel, the tafasitamab and lenalidomide combination was dominant, as it was more effective (gained 2.27 QALYs more) and less costly.

CONCLUSIONS: Tafasitamab and lenalidomide combination followed by tafasitamab monotherapy is projected to be cost-effective or dominant compared with most approved regimens for the treatment of patients with R/R DLBCL not eligible for ASCT in Greece.