Liso-cel Versus Mosunetuzumab in Follicular Lymphoma: Cost, Clinical Outcomes, Time Toxicity

Although lisocabtagene maraleucel (liso-cel) has a higher total cost than mosunetuzumab, it provides increased survival and reduced time toxicity, travel distance, and productivity loss for patients with third-line or later follicular lymphoma (3L+ FL), according to a study presented at the 66^th American Society of Hematology Annual Meeting & Exposition in San Diego, California.

To estimate patient survival and progression-free survival (PFS), the researchers created a health economic model using parametric techniques in Microsoft Excel. Time toxicity, clinical outcomes, and economic outcomes were estimated over three timespans: 1–5 years, 10 years, and lifetime. Five years was used as the base case.

Patients received either one administration of liso-cel or eight infusions of mosunetuzumab. Patients treated with liso-cel also received leukapheresis, bridging therapy, and lymphodepletion, which contributed to pretreatment costs. Indirect costs included travel costs for outpatient visits or hospitalizations, as well as lost wages. Productivity loss accounted for eight hours of productive time loss while receiving care. Time toxicity (time spent receiving medical care) accounted for every occurrence of patient outpatient visits, laboratory tests, and other health care resource utilization (HCRU).

Over a period of five years, patients treated with liso-cel had a higher median PFS than those treated with mosunetuzumab (51 months vs 18 months, respectively). The cost per median PFS month was lower with liso-cel than mosunetuzumab ($11,650 vs $18,180, respectively). However, due to the high costs of liso-cel, patients treated with the chimeric antigen receptor T-cell therapy incurred an extra $265,226.

Due to more infusion visits and disease progression, the time toxicity for patients treated with mosunetuzumab was 44 days longer than for those treated with liso-cel. The researchers noted that “As the time horizon increased, this differential widened due to worse disease progression.”

Patients treated with mosunetuzumab had an increased HCRU, including an additional 1,148 hours in productivity loss, $3,126 in lost wages, 246 more miles traveled, and an extra $1,323 in transportation costs.

“The increase in PFS with liso-cel versus mosunetuzumab translates to less downstream HCRU,” the researchers concluded. “Further, as liso-cel only requires a single administration, it provides reduced time toxicity, travel distance, and productivity loss, which improve the quality of life of patients and their caregivers.”

Reference

Dahiya S, Saunders AC, Kumar J, et al. “Cost consequence and time toxicity model for the treatment of third-line or later (3L+) follicular lymphoma (FL) using advanced therapies: a comparison of lisocabtagene maraleucel (liso-cel) with mosunetuzumab.” Abstract # 3651. Presented at the 66th American Society of Hematology Annual Meeting & Exposition; December 7-10, 2024; San Diego, California.