PMID- 35443867
OWN - NLM
STAT- MEDLINE
DCOM- 20220504
LR  - 20220531
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 25
IP  - 1
DP  - 2022 Jan-Dec
TI  - Cost-effectiveness of axicabtagene ciloleucel versus lisocabtagene maraleucel for 
      adult patients with relapsed or refractory large B-cell lymphoma after two or 
      more lines of systemic therapy in the US.
PG  - 541-551
LID - 10.1080/13696998.2022.2065787 [doi]
AB  - AIMS: This study evaluated from a US payer perspective the cost-effectiveness of 
      two chimeric antigen receptor T (CAR T) cell therapies, axicabtagene ciloleucel 
      (axi-cel) versus lisocabtagene maraleucel (liso-cel), for the treatment of adult 
      patients with relapsed or refractory (r/r) large B-cell lymphoma (LBCL) following 
      two or more systemic therapy lines. METHODS: We developed a 3-state (i.e., 
      pre-progression, post-progression, death) partitioned survival model to estimate 
      patients' lifetime outcomes. Mixture cure models were used for survival 
      extrapolation to account for long-term remission. Survival inputs were based on a 
      matching-adjusted indirect comparison (MAIC) that reweighted the ZUMA-1 
      population (receiving axi-cel) to match patient characteristics in 
      TRANSCEND-NHL-001 (assessing liso-cel). Costs included apheresis, drug 
      acquisition, and administration for conditioning chemotherapy and CAR T 
      therapies, monitoring, transplant, hospitalization, adverse events, routine care, 
      and terminal care, per published literature and databases. Utilities were derived 
      from ZUMA-1 and literature. Deterministic and probabilistic sensitivity analyses 
      were conducted. RESULTS: In the base case, axi-cel was associated with more QALYs 
      (7.76 vs. 5.94) and greater costs overall ($611,440 vs. $597,174) than liso-cel, 
      at $7,843/QALY gained. The incremental costs (+$14,266) were largely driven by 
      higher routine care costs (+$18,596) due to longer survival and hospitalization 
      (+$10,993) but partially offset by reduced costs of CAR T acquisition (‒$11,300) 
      and terminal care (‒$4,025). Sensitivity analyses consistently suggested 
      robustness of base-case results. LIMITATIONS: This study relied on an MAIC in 
      which trial design differences and unobserved confounders could not be accounted 
      for. Future real-world studies for recently approved CAR T are warranted to 
      validate our results. Due to a lack of data, we assumed equivalent use of 
      transplants and treatment for B-cell aplasia between the two therapies based on 
      clinicians' opinions. CONCLUSIONS: In the US, axi-cel is a potentially 
      cost-effective treatment option compared with liso-cel for adult patients with 
      r/r LBCL after two or more systemic therapy lines.
FAU - Oluwole, Olalekan O
AU  - Oluwole OO
AUID- ORCID: 0000-0001-8525-9641
AD  - Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
FAU - Liu, Rongzhe
AU  - Liu R
AUID- ORCID: 0000-0001-8316-6089
AD  - OPEN Health Company, Bethesda, MD, USA.
FAU - Diakite, Ibrahim
AU  - Diakite I
AUID- ORCID: 0000-0001-7151-4330
AD  - OPEN Health Company, Bethesda, MD, USA.
FAU - Feng, Chaoling
AU  - Feng C
AUID- ORCID: 0000-0003-4654-4305
AD  - Kite, A Gilead Company, Santa Monica, CA, USA.
FAU - Patel, Anik
AU  - Patel A
AD  - Kite, A Gilead Company, Santa Monica, CA, USA.
FAU - Nourhussein, Iman
AU  - Nourhussein I
AUID- ORCID: 0000-0003-3271-7439
AD  - OPEN Health Company, Bethesda, MD, USA.
FAU - Snider, Julia Thornton
AU  - Snider JT
AUID- ORCID: 0000-0003-0017-4863
AD  - Kite, A Gilead Company, Santa Monica, CA, USA.
FAU - Locke, Frederick L
AU  - Locke FL
AUID- ORCID: 0000-0001-9063-6691
AD  - Moffitt Cancer Center, Tampa, FL, USA.
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Antigens, CD19)
RN  - 0 (Biological Products)
RN  - 0 (Receptors, Chimeric Antigen)
RN  - U2I8T43Y7R (axicabtagene ciloleucel)
SB  - IM
MH  - Adult
MH  - Antigens, CD19/economics/therapeutic use
MH  - Biological Products/economics/therapeutic use
MH  - Cost-Benefit Analysis
MH  - Humans
MH  - *Lymphoma, Large B-Cell, Diffuse/drug therapy
MH  - *Receptors, Chimeric Antigen/therapeutic use
OTO - NOTNLM
OT  - C
OT  - C01
OT  - Cost-effectiveness
OT  - O
OT  - O5
OT  - O51
OT  - anti-CD19 chimeric antigen receptor T-cell
OT  - axicabtagene ciloleucel (axi-cel)
OT  - large B-cell lymphoma
OT  - lisocabtagene maraleucel (liso-cel)
OT  - matching-adjusted indirect comparison
OT  - mixture cure model
OT  - quality-adjusted life years
OT  - survival analysis
EDAT- 2022/04/22 06:00
MHDA- 2022/05/06 06:00
CRDT- 2022/04/21 05:21
PHST- 2022/04/22 06:00 [pubmed]
PHST- 2022/05/06 06:00 [medline]
PHST- 2022/04/21 05:21 [entrez]
AID - 10.1080/13696998.2022.2065787 [doi]
PST - ppublish
SO  - J Med Econ. 2022 Jan-Dec;25(1):541-551. doi: 10.1080/13696998.2022.2065787.