OBJECTIVES:

Diffuse Large B-cell Lymphoma (DLBCL) is the most frequent type of aggressive non-Hodgkin lymphoma (NHL) in adults. MOR208 is an anti-CD19 antibody, currently investigated in combination with Lenalidomide (LEN) in patients with relapsed or refractory(R/R) DLBCL. We investigated the cost-effectiveness of the MOR208+LEN combination in a patient-level simulation model.

METHODS:

Based on an estimate of the median overall and progression-free survival from the L-MIND study for MOR208+LEN, literature benchmarks and expert input, treatment pathways were incorporated into a patient-level discrete event model for DLBCL to reflect the heterogeneity and complexity of treatment options. A US setting of care was investigated, with drug costs utilizing manufacturers’ average sales prices. For the MOR208+LEN combination a hypothetical drug cost range between 200k and 600k USD was modeled out. The discrete event cost-effectiveness model was constructed in TreeAge 2018 software, adopting payor perspective and 3% discount rate for outcomes and costs.

RESULTS:

Median overall survival for R/R DLBCL patients treated with MOR208+LEN in the L-MIND trial has not been reached [95% CI: 18.6; not reached], mFU 12.4 months. Incremental costs per life year gained (LYG) were calculated to range between 60k and 330k USD. Results were not sensitive to changes in survival of +/-50%. When considering the full treatment pathway with ~80% response rate to first line treatment, second line treatment with MOR208+LEN yielded similar incremental costs per LYG.

CONCLUSIONS:

Treatment pathway of DLBCL patients was investigated based on survival times. Cost-effective results per LYG were obtained for a broad range of MOR208+LEN costs in the simulations. Important study limitations include limited long-term survival data and changing treatment landscape.