Cost-effectiveness of axicabtagene ciloleucel versus lisocabtagene maraleucel for adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy in the US. (31st December 2022)

• Record Type: Journal Article
• Authors: Oluwole, Olalekan O.; Liu, Rongzhe; Diakite, Ibrahim; Feng, Chaoling; Patel, Anik; Nourhussein, Iman; Snider, Julia Thornton; Locke, Frederick L.
• Is Part Of: Journal of medical economics. Volume 25:Number 1(2022)
• Page Start: 541
• Page End: 551
• Publication Date: 2022-12-31
• Subjects: Cost-effectiveness -- large B-cell lymphoma -- anti-CD19 chimeric antigen receptor T-cell -- axicabtagene ciloleucel (axi-cel) -- lisocabtagene maraleucel (liso-cel) -- mixture cure model -- survival analysis -- matching-adjusted indirect comparison -- quality-adjusted life years; C01 -- C -- O51 -- O5 -- O; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2022.2065787
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Aims: This study evaluated from a US payer perspective the cost-effectiveness of two chimeric antigen receptor T (CAR T) cell therapies, axicabtagene ciloleucel (axi-cel) versus lisocabtagene maraleucel (liso-cel), for the treatment of adult patients with relapsed or refractory (r/r) large B-cell lymphoma (LBCL) following two or more systemic therapy lines. Methods: We developed a 3-state (i.e., pre-progression, post-progression, death) partitioned survival model to estimate patients' lifetime outcomes. Mixture cure models were used for survival extrapolation to account for long-term remission. Survival inputs were based on a matching-adjusted indirect comparison (MAIC) that reweighted the ZUMA-1 population (receiving axi-cel) to match patient characteristics in TRANSCEND-NHL-001 (assessing liso-cel). Costs included apheresis, drug acquisition, and administration for conditioning chemotherapy and CAR T therapies, monitoring, transplant, hospitalization, adverse events, routine care, and terminal care, per published literature and databases. Utilities were derived from ZUMA-1 and literature. Deterministic and probabilistic sensitivity analyses were conducted. Results: In the base case, axi-cel was associated with more QALYs (7.76 vs. 5.94) and greater costs overall ($611, 440 vs. $597, 174) than liso-cel, at $7, 843/QALY gained. The incremental costs (+$14, 266) were largely driven by higher routine care costs (+$18, 596) due to longer survival and hospitalization (+$10, 993) but partially offset by reduced costs of CAR T acquisition (‒$11, 300) and terminal care (‒$4, 025). Sensitivity analyses consistently suggested robustness of base-case results. Limitations: This study relied on an MAIC in which trial design differences and unobserved confounders could not be accounted for. Future real-world studies for recently approved CAR T are warranted to validate our results. Due to a lack of data, we assumed equivalent use of transplants and treatment for B-cell aplasia between the two therapies based on clinicians' opinions. Conclusions: In the US, axi-cel is a potentially cost-effective treatment option compared with liso-cel for adult patients with r/r LBCL after two or more systemic therapy lines.