At an age-adjusted life-year (QALY) threshold of $200,000 per quality-adjusted life-year (QALY), neither second-line axicabtagene ciloleucel (axi-cel) nor lisocabtagene maraleucel (liso-cel) was cost-effective in patients as second-line treatment of diffuse large B-cell lymphoma (DLBCL), researchers report. A second-line option is important since only about 60% of patients with DLBCL achieve durable remission, and salvage chemoimmunotherapy and consolidative autologous stem cell transplantation (ASCT) are effective in only 20% of patients with relapsed or refractory disease.
This study uses comparative and observational trial data in a state-transition microsimulation model. Using a lifetime horizon and the perspective of the healthcare sector, cost-effectiveness analysis was conducted. The incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (iNMB) are based on a willingness-to-pay (WTP) of $200,000 (U.S. dollars) per QALY.
“The increase in median overall survival was 4 months for axi-cel and 1 month for liso-cel,” the authors write. “For axi-cel, the ICER was $684,225 per QALY and the iNMB was −$107,642. For liso-cel, the ICER was $1, 171 ,909 per QALY and the iNMB was −$102,477.”
Sensitivity analysis showed that, “to be cost-effective with a WTP of $200,000, the cost of CAR-T would have to be reduced to $321,123 for axi-cel and $313,730 for liso-cel. Implementation in high-risk patients would increase U.S. health care spending by approximately $6.8 billion over a 5-year period.”