Second-line CAR-T too costly for treatment of diffuse large B-cell lymphoma

Second-line treatment with axicabtagene ciloleucel (axi-cel) or lisocabtagene maraleucel (liso-cel) helps improve survival in high-risk patients with diffuse large B-cell lymphoma (DLBCL), but both therapies are expensive, a study has shown.

“Clinical outcomes improved incrementally, but costs of chimeric antigen receptor T-cell therapy (CAR-T) must be lowered substantially to enable cost-effectiveness,” the investigators said.

This study utilized a state-transition microsimulation model and obtained data from ZUMA-7, TRANSFORM, other trials, and observational data. High-risk patients with DLBCL underwent treatment with axi-cel or liso-cel compared with autologous stem cell transplantation (ASCT).

Outcomes measured included the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (iNMB) in 2022 US dollars per QALY for a willingness-to-pay (WTP) threshold of $200,000 per QALY.

Base-case analysis revealed an increase in median overall survival of 4 months for axi-cel and 1 month for liso-cel. The ICER for axi-cel was $684,225 per QALY, and this iNMB was ‒$107,642. For liso-cel, the ICER and iNMB were $1,171,909 and ‒$102,477, respectively.

In sensitivity analysis, results showed that the cost of CAR-T must be reduced to $321,123 for axi-cel and to $313,730 for liso-cel for these treatments to be cost-effect with a WTP of $200,000. Additionally, implementation in high-risk patients would increase US healthcare spending by nearly $6.8 billion over a 5-year period.

The study was limited by differences in preinfusion bridging therapies, which barred cross-trial comparisons.

“The ZUMA-7 and TRANSFORM trials demonstrated superior event-free survival in primary-refractory or early-relapsed DLBCL with CAR-T compared with salvage chemoimmunotherapy and consolidative ASCT,” the investigators said. “[H]owever, list prices for CAR-T exceed $400,000 per infusion.”