OBJECTIVES: This US payer-perspective model compares lifetime costs and benefits for CAR T-treated R/R LBCL patients, by product (axicabtagene ciloleucel [axi-cel] vs. tisagenlecleucel [tisa-cel] / lisocabtagene maraleucel [liso-cel]), accounting for CAR T infusion setting (inpatient vs. outpatient) within authorized treatment centers.

METHODS: We applied unit costs to Anlitiks All-Payor Claims (AAPC) summary utilization data (2016-2020; N=1175), stratified by infusion setting, cytokine release syndrome (CRS), and neurologic event (NE) status, to estimate three-month costs following CAR T infusion. CAR T product- and setting-specific grade 3+ CRS/NE incidence rates were imputed from published trial data assuming higher rates among those infused in an inpatient setting. Quality-adjusted life-years (QALYs) and long-term costs (3% annual discount) were calculated using published product-specific overall and progression-free survival data without respect to setting. Direct costs of other LBCL treatments, intravenous immune globulin, and end-of-life care were also included. In the base-case, an outpatient proportion (17%) derived from AAPC was assumed for all products. Other base-case inputs for axi-cel were informed by ZUMA-1 trial cohorts 1 & 2. Alternative scenarios included outpatient proportions of 0% and 34% and data from ZUMA-1 cohort 4 and cohort 6 with updated safety management.

RESULTS: Under all scenarios, total QALYs for axi-cel exceeded those for tisa-cel (7.4 vs. 5.1) and liso-cel (7.7 vs. 5.9). In the base case, total costs for axi-cel exceeded those for tisa-cel ($632K vs. $577K) and liso-cel ($637K vs. $621K). Three-month post-infusion costs ranged from $57K to $59K across all products. Results were not sensitive to alternative outpatient proportions or inputs informed by ZUMA-1 cohort(s), including grade 3+ CRS/NE incidence. In all scenarios, axi-cel was cost-effective vs. both comparator products at maximum willingness-to-pay of $30K/QALY.

CONCLUSIONS: Axi-cel is a cost-effective CAR T option for patients with R/R LBCL compared to tisa-cel and liso-cel, regardless of infusion setting.