OBJECTIVES: This review aims to review existing evidence on the cost-effectiveness of the six CAR T-cell therapies across different international jurisdictions.

METHODS: We conducted a systematic review using PubMed, Scopus and Web of Science databases to identify economic evaluations published until 29 November 2022. The methodological quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), 2022 edition. Studies were included if they were full economic evaluations (within-trial and model-based). Extracted data was grouped according to type of CAR T-cell therapy and summarised narratively.

RESULTS: The review included 29 full cost-effectiveness studies: tisagenlecleucel (n = 14), axicabtagene ciloleucel (n = 6), axicabtagene ciloleucel with tisagenlecleucel (n = 3), brexucabtagene autoleucel (n = 4), and lisocabtagene maraleucel (n = 2). Incremental costs varied considerably between $US1407 and $US606,010, whereas QALYs gained ranged from 0.81 to 10.77 over a lifetime horizon. The highest incremental QALY was reported for tisagenlecleucel in the Netherlands, Singapore and Spain; 10.77, 9.87 and 8.97 for use in paediatric, relapsed/refractory B-cell acute lymphoblastic leukaemia (ALL). The highest incremental cost ($US606,010) was associated with the use of axicabtagene ciloleucel therapy in Canada for diffuse large B-cell lymphoma (DLBCL) and US (US$439,500), and brexucabtagene autoleucel for mantle cell lymphoma in the UK (US$367,423). The main cost-driver of the total cost were attributed to the price of the CAR T-cell therapy.

CONCLUSIONS: To our knowledge, this is the most up-to-date literature review on the cost-effectiveness of existing CAR T-cell therapies. It finds uncertainty was not limited to evidence generation but extended to the affordability of CAR T-cell therapies. Existing reimbursement models for CAR T-cell therapies are not fit for propose. This review highlights the need for robust evidence to address considerable uncertainty in the cost and effectiveness data given the magnitude of differences in cost-effectiveness estimates.