OBJECTIVES: To evaluate the cost-effectiveness of lisocabtagene maraleucel (liso-cel) versus standard of care (SoC) as a second-line (2L) treatment for transplant-eligible adult patients with diffuse large B-cell lymphoma (DLBCL), high grade B-cell lymphoma (HGBCL), primary mediastinal large B-cell lymphoma (PMBCL) and follicular lymphoma grade 3B (FL3B) in the Netherlands from a societal perspective.

METHODS: A partitioned-survival model was developed in R, as part of the R pilot initiated by the Dutch National Health Care Institute (ZIN), using efficacy, safety, and utility data from the Phase III TRANSFORM study. Mixture-cure models were chosen for survival extrapolations to reflect the extended survival seen with chimeric antigen receptor (CAR)-T cell therapies. Costs were Dutch-specific with an annual discount rate of 4% for costs and 1.5% for health outcomes. Direct medical costs and costs for transportation, accommodation, informal care and productivity loss were applied to capture the full societal costs of treatment. Outcomes were life years (LYs), quality-adjusted LYs (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs). Probabilistic sensitivity analysis (PSA) was conducted to assess the uncertainty in the model.

RESULTS: Using a lifetime horizon, the total QALYs were 11.57 for liso-cel and 9.06 for SoC yielding an incremental benefit of 2.51 QALYs. Total costs were €481,414 for liso-cel and €379,078 for SoC, with incremental costs of €102,337. The deterministic ICER was €40,836/QALY. The PSA resulted in a mean ICER of €45,777/QALY and showed that at the relevant willingness-to-pay (WTP) threshold of €50,000/QALY, liso-cel has a 56% chance of being cost-effective versus SoC.

CONCLUSIONS: In conclusion, our study presents compelling evidence supporting the cost-effectiveness of liso-cel as a valuable addition for the 2L treatment of patients with DLBCL, HGBCL, PMBCL and FL3B in the Netherlands. The ICER of €40,836/QALY gained falls below the relevant WTP threshold of €50,000/QALY.