A Cost-Effectiveness Analysis of Axicabtagene Ciloleucel versus Tisagenlecleucel in the Treatment of Diffuse Large B-cell Lymphoma Based on a Real-World French Registry

• Published in: Advances in therapy 2024-11, Vol.41 (11), p.4282-4298
• Main Authors: Ray, Markqayne, Castaigne, Jean-Gabriel, Zang, Alexandra, Patel, Anik, Hancock, Elizabeth, Brighton, Nicholas, Bachy, Emmanuel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antigens, CD19 - economics; Antigens, CD19 - immunology; Antigens, CD19 - therapeutic use; Biological Products - economics; Biological Products - therapeutic use; Cardiology; Cost-Benefit Analysis; Cost-Effectiveness Analysis; Endocrinology; Female; France; Humans; Immunotherapy, Adoptive - adverse effects; Immunotherapy, Adoptive - economics; Immunotherapy, Adoptive - methods; Internal Medicine; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - economics; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Research; Pharmacology/Toxicology; Receptors, Antigen, T-Cell - therapeutic use; Registries; Rheumatology
• ISSN: 0741-238X; 1865-8652; 1865-8652
• DOI: 10.1007/s12325-024-02971-1

Introduction Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are chimeric antigen receptor T-cell therapies that were evaluated in third and later line (3L+) relapsed or refractory (r/r) diffuse large B-cell lymphoma (DLBCL) in the ZUMA-1 and JULIET trials, respectively. As of October 2021, the DESCAR-T registry included 729 French patients with 3L+ r/r DLBCL who received axi-cel or tisa-cel. Using these data, propensity score matching was used to conduct an adjusted comparison between axi-cel and tisa-cel. Axi-cel was associated with statistically significant improvements in overall survival (OS) and progression-free survival (PFS), and significantly more frequent Grade ≥ 3 immune effector cell-associated neurotoxicity syndrome (ICANS), compared with tisa-cel. There was no significant difference in Grade ≥ 3 cytokine release syndrome (CRS). The current analysis assessed the cost-effectiveness of axi-cel versus tisa-cel in the treatment of 3L+ r/r DLBCL using propensity score-matched data from the DESCAR-T registry. Methods A partitioned survival model was used to extrapolate costs and quality-adjusted life years (QALYs) over a lifetime. Survival curves for PFS and OS were based on independent mixture cure models fitted to digitized Kaplan–Meier data for the propensity score-matched DESCAR-T populations. Average duration of intensive care unit stays for each of axi-cel and tisa-cel in DESCAR-T were used to inform adverse event costs. Selected parametric survival distributions were based on clinical expert validation. Utility values were derived from ZUMA-1, and costs were obtained from French registries and published sources. List prices were used for both axi-cel and tisa-cel. Costs and outcomes were discounted at an annual rate of 2.5%. Results Axi-cel is associated with an incremental cost-effectiveness ratio of €15,520 per QALY compared with tisa-cel. Conclusion Based on explicit willingness-to-pay thresholds applied in Europe, axi-cel is expected to be a cost-effective use of healthcare resources in real-world clinical settings compared with tisa-cel in 3L+ r/r DLBCL.