OBJECTIVES: To assess the cost-effectiveness of two chimeric antigen receptor T-cell (CAR T) therapies available in Canada, axi-cel and tisa-cel, for treatment of relapsed/refractory (R/R) large B-cell lymphoma (LBCL) after ≥2 lines of systemic therapy from a Canadian public payer perspective over a lifetime horizon.

METHODS: Clinical data were derived from the ZUMA-1 and JULIET clinical trials. In absence of head-to-head randomized controlled trial (RCT) evidence, survival data from ZUMA-1 were re-weighted through a propensity score matching-adjusted indirect comparison (MAIC) to match the JULIET population. Survival estimates for both therapies were extrapolated using standard parametric fitted curves. A partitioned survival mixture cure modeling approach was taken to characterize the potential curative effect of CAR T therapy in LBCL. Healthcare resource utilization and adverse event data were based on data from ZUMA-1 and JULIET and validated by Canadian clinical experts. Utility values were derived from ZUMA-1 and supplemented with published literature. Costs were derived from publicly available Canadian cost databases and published oncology literature. Sensitivity analyses were conducted to assess robustness of results.

RESULTS: In the base case, axi-cel generated an incremental 3.42 discounted life-years compared to tisa-cel, corresponding to 2.91 discounted additional quality-adjusted life-years (QALYs). Axi-cel was associated with $24,310 in additional costs, and $8,341 per QALY gained compared with tisa-cel. Key drivers of the analysis included CAR T acquisition costs, off-treatment utility values, and hospitalization duration. Observed results were consistent over a wide range of sensitivity analyses. At commonly cited willingness-to-pay thresholds in oncology, the probability of axi-cel being cost-effective versus tisa-cel was 99.7%.

CONCLUSIONS: From a public payer perspective, axi-cel represents a cost-effective allocation of resources compared with tisa-cel for treatment of R/R LBCL in Canada. Comparisons between trials are limited by potential bias and further data is needed to compare efficacy differences between individual CAR T cell products and/or other therapies.