An updated cost-effectiveness analysis of axicabtagene ciloleucel in second-line large B-cell lymphoma patients in the United States
- Author(s)
- Oluwole, OO; Patel, AR; Vadgama, S; Smith, NJ; Blissett, R; Feng, C; Dickinson, M; Johnston, PB; Perales, MA;
- Details
- Publication Year 2024-01,Volume 27,Issue #1,Page 77-83
- Journal Title
- Journal of Medical Economics
- Publication Type
- Research article
- Abstract
- AIMS: This economic evaluation of axicabtagene ciloleucel (axi-cel) versus previous standard of care (SOC; salvage chemotherapy followed by high-dose therapy with autologous stem cell rescue) in the second line (2L) large B-cell lymphoma population is an update of previous economic models that contained immature survival data. METHODS: This analysis is based on primary overall survival (OS) ZUMA-7 clinical trial data (median follow-up of 47.2 months), from a United States (US) payer perspective, with a model time horizon of 50 years. Mixture cure models were used to extrapolate updated survival data; subsequent treatment data and costs were updated. Patients who remained in the event-free survival state by 5 years were assumed to have achieved long-term remission and not require subsequent treatment. RESULTS: Substantial survival and quality of life benefits were observed despite 57% of patients in the SOC arm receiving subsequent cellular therapy: median model-projected (ZUMA-7 trial Kaplan-Meier estimated) OS was 78 months (median not reached) for axi-cel versus 25 months (31 months) for SOC, resulting in incremental quality-adjusted life year (QALY) difference of 1.63 in favor of axi-cel. Incrementally higher subsequent treatment costs were observed in the SOC arm due to substantial crossover to cellular therapies, thus, when considering the generally accepted willingness to pay threshold of $150,000 per QALY in the US, axi-cel was cost-effective with an incremental cost-effectiveness ratio of $98,040 per QALY. CONCLUSIONS: Results remained consistent across a wide range of sensitivity and scenario analysis, including a crossover adjusted analysis, suggesting that the mature OS data has significantly reduced the uncertainty of axi-cel's cost-effectiveness in the 2L setting in the US. Deferring treatment with CAR T therapies after attempting a path to transplant may result in excess mortality, lower quality of life and would be an inefficient use of resources relative to 2L axi-cel.
- Keywords
- Humans; United States; Cost-Effectiveness Analysis; Quality of Life; *Lymphoma, Large B-Cell, Diffuse/drug therapy; *Biological Products/therapeutic use; Axicabtagene ciloleucel; C; C5; C59; CAR T-cell therapy; I; I1; I19; cost-effectiveness; lymphoma; mixture cure model; survival analysis
- Department(s)
- Clinical Haematology
- Publisher's Version
- https://doi.org/10.1080/13696998.2023.2290832
- Open Access at Publisher's Site
https://doi.org/10.1080/13696998.2023.2290832- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-01-19 06:43:10
Last Modified: 2024-01-19 06:48:25