Cost-Effectiveness Analysis of Axicabtagene Ciloleucel, Lisocabtagene Maraleucel, and Tisagenlecleucel CAR T-Cell Therapies for Treatment of Relapsed or Refractory Large B-Cell Lymphoma (LBCL)
Author(s)
Ghanem B1, Seoane-Vazquez E2, Fleming M3, Brown LM2, Rodriguez-Monguio R2
1Chapman University School of Pharmacy, Costa Mesa, CA, USA, 2Chapman University School of Pharmacy, Irvine, CA, USA, 3Chapman University, Irvine, CA, USA
Presentation Documents
BACKGROUND: Axicabtagene ciloleucel (axi-cel), lisocabtagene Maraleucel (liso-cel), and tisagenlecleucel (tisa-cel) are chimeric antigen receptor (CAR) T-cell therapies used to treat adult patients with large B-cell lymphoma (LBCL) who relapsed within 12 months of first line therapy. However, no head-to-head clinical trials have been conducted to compare them.
OBJECTIVES:
To estimate the cost-effectiveness of axi-cel versus liso-cel versus tisa-cel in patients with relapsed/refractory LBCL (rrLBCL) from a US healthcare payer perspective. METHODS: The primary outcomes included quality of life (QoL) and quality-adjusted life years (QALYs). Gained outcomes and adverse events were derived from the pivotal trials (ZUMA-7, TRANSFORM, and BELINDA) and literature reviews. Costs were extracted from the IBM-Micromedex Red Book, Centers for Medicare and Medicaid Services, and existing literature. Probabilistic sensitivity analyses were performed. RESULTS: The total costs of drug acquisition, administration, and adverse event management per patient were $541,026, $491,759, and $463,368, for axi-cel, liso-cel, and tisa-cel, respectively. Total QALYs for axi-cel exceeded liso-cel (7.24 versus 5.52) and tisa-cel (6.85 versus 4.86) with incremental costs per QALY gained of $28,644 versus liso-cel and $39,024 versus tisa-cel. The probability that the gene therapy is cost-effective was 99% at a willingness to pay $150,000 per QALY. CONCLUSIONS: Axi-cel is a cost-effective CAR T cell therapy for patients with rrLBCL compared to liso-cel and tisa-cel. More studies based on head-to-head clinical trials are necessary to confirm these findings.Conference/Value in Health Info
2023-05, ISPOR 2023, Boston, MA, USA
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
EE86
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Drugs, Oncology, Rare & Orphan Diseases