Value for Money of CAR-T Cell Therapy for Patients with Diffuse Large B-cell Lymphoma in China: Evidence from a Cost-Effectiveness Analysis

Weijia Wu, Yuping Zhou, Yannan Wang, Syed Afroz Keramat, Namal N. Balasooriya, Zixuan Zhao, Yi Yang, Tracy Comans and Hengjin Dong ()
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Weijia Wu: Zhejiang University School of Medicine
Yuping Zhou: Zhejiang University
Yannan Wang: Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College
Syed Afroz Keramat: Queensland of University
Namal N. Balasooriya: Queensland of University
Zixuan Zhao: Zhejiang University School of Medicine
Yi Yang: Zhejiang University School of Medicine
Tracy Comans: Queensland of University
Hengjin Dong: Zhejiang University School of Medicine

Applied Health Economics and Health Policy, 2023, vol. 21, issue 5, No 8, 773-783

Abstract: Abstract Objective This research assesses the cost effectiveness of Axicabtagene ciloleucel (Axi-cel), Tisagenlecleucel (Tis-cel), Relmacabtagene autoleucel (Rel-cel) and Lisocabtagene maraleucel (Lis-cel) against standard of care (SOC) for patients with diffuse large B-cell lymphoma (DLBCL) in the first-line setting (1L), second-line setting (2L) and third-line or later setting (3L+). Methods Markov modelling based on a flexible survival model was adopted to evaluate four chimeric antigen receptor T-cell (CAR-T) therapies compared with SOC for patients with diffuse large B-cell lymphoma (DLBCL). The clinical inputs and utility values of the model were derived from the most recent clinical trials and the health care costs from a Chinese provincial clinical center. Costs and quality-adjusted life years (QALYs) were used to derive incremental cost-effectiveness ratios (ICERs) from the Chinese health care system perspective. Results The ICER of Axi-cel (1L) versus SOC was approximately Chinese Yuan (CNY) 2,125,311 per QALY. The ICER for Axi-cel (2L), Tis-cel (2L) and Liso-cel (2L)) versus SOC in transplant-eligible patients were approximately CNY363,977, CNY32,066,781 and CNY347,746 per quality-adjusted life year (QALY), respectively. The ICER for Liso-cel (2L) versus SOC in transplant-ineligible patients was approximately CNY1,233,972 per QALY. The ICERs for Axi-cel (3L+), Tis-cel (3L+), Rel-cel (3L+) and Liso-cel (3L+) versus SOC were approximately CNY346,009, CNY654,344, CNY280,964 and CNY436,858 per QALY, respectively. In the scenario analysis using mixture cure models, the long-term survival benefit for CAR-T and SOC groups was found higher, and only Rel-cel (3L+) was found to be cost effective. Conclusion Our results demonstrated that CAR-T treatments are not cost effective in any-line settings for DLBCL patients at the WHO-recommended willingness-to-pay threshold (CNY257,241 per QALY) in the base-case analysis. Price reduction of CAR-T therapies is the main approach for lowering ICERs and ensuring that the drug costs are proportional to patient health benefits.

Date: 2023
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DOI: 10.1007/s40258-023-00817-5

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