Study Identifies Most Cost-Effective CAR T-Cell Therapy in Patients with R/R LBCL

Axicabtagene ciloleucel is the most cost-effective chimeric antigen receptor (CAR) T-cell therapy for patients with relapsed or refractory large B cell lymphoma (LBCL) among the three anti-CD19 CAR T-cell therapies currently approved for relapsed/refractory LBCL by the U.S. Food and Drug Administration (FDA).

The results, published in Advances in Therapy, showed that for patients with relapsed/refractory LBCL, axicabtagene ciloleucel confers a greater survival benefit than other two approved CAR-T therapies, lisocabtagene maraleucel and tisagenlecleucel, and is also the most cost-effective among the three therapies.

The study also showed that the cost-effectiveness of the CAR T-cell therapies was not affected by site of care (ie, inpatient vs outpatient infusion).

The researchers constructed a payer perspective decision tree model to compare lifetime payer costs and health benefits of the three FDA-approved anti-CD19 CAR T-cell therapies for patients with relapsed/refractory LBCL in the United States.

The study addressed the cost-effectiveness and value of the CAR T-cell therapies for patients with relapsed/refractory LBCL who previously received at least two lines of systemic therapy over time horizons ranging from three months to patient lifetime, with health benefits captured in the form of quality-adjusted life-years (QALYs).

Tisagenlecleucel had the lowest total health care cost followed by lisocabtagene maraleucel and axicabtagene ciloleucel. CAR T-cell acquisition contributed to the largest proportion of these costs and explained most of the total cost differences between therapies. Post-infusion hematopoietic stem cell transplantation costs were also lower for tisagenlecleucel than for lisocabtagene maraleucel or axicabtagene ciloleucel. Intravenous immunoglobulin costs were lowest for lisocabtagene maraleucel. Inpatient costs, including intensive care unit (ICU) and non-ICU days, and outpatient and emergency department costs were similar across CAR T-cell therapies.

Life years, including pre-progression and post-progression life-years, were highest for axicabtagene ciloleucel. In turn, QALYs were also the highest for axicabtagene ciloleucel in both comparisons, with the greatest differences between therapies occurring in the pre-progression period, which was longest for axicabtagene ciloleucel. Because only living patients receive routine care, the additional life years associated with axicabtagene ciloleucel also explain why long-term costs of routine care are highest for axicabtagene ciloleucel.

“This model showed that [axicabtagene ciloleucel] was more cost-effective for patients with relapsed/refractory LBCL compared to [lisocabtagene maraleucel] and [tisagenlecleucel],” the authors wrote. “These results held regardless of site of care for the initial and CAR T-cell therapy.”

Cummings Joyner AK, Snider JT, Wade SW, et al. Cost-effectiveness of chimeric antigen receptor T cell therapy in patients with relapsed or refractory large b cell lymphoma: no impact of site of care. Adv Ther. 2022. doi:10.1007/s12325-022-02188-0