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

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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.

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Authors and Affiliations

  1. Department of Science and Education of the Fourth Affiliated Hospital, Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China

    Weijia Wu, Zixuan Zhao, Yi Yang & Hengjin Dong

  2. Faculty of Medicine, Centre for Health Services Research, Queensland of University, Brisbane, Australia

    Weijia Wu, Syed Afroz Keramat, Namal N. Balasooriya & Tracy Comans

  3. Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

    Yuping Zhou

  4. Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China

    Yuping Zhou

  5. Institute of Hematology, Zhejiang University, Hangzhou, China

    Yuping Zhou

  6. Center for Clinical Pharmacy, Cancer Center, Clinical Research Institute, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Zhejiang, China

    Yannan Wang

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  1. Weijia Wu
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Correspondence to Hengjin Dong.

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Funding

This study is funded by China Scholarship Council (CSC, 2022062320370) and Zhejiang Pharmaceutical Association Economics and Health Technology Evaluation Special Scientific Research Funding Project (2022-SKY-A07054-0007).

Data availability

The data presented in this study are available on request from the corresponding author.

Conflict of interest

The authors declare no conflict of interest.

Ethics approval

This research was approved by the institutional review board of the First Affiliated Hospital, School of Medicine, Zhejiang University and performed according to the Declaration of Helsinki.

Author contributions

Wu, and Zhou developed the economic model, performed the analyses, collected and reviewed the data. Wang, Zhao, and Yang interpreted the results and drafted the manuscript. All authors reviewed the data, interpreted the result and revised the manuscript. Comans and Dong supervised the whole study.

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Not applicable.

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Wu, W., Zhou, Y., Wang, Y. et al. Value for Money of CAR-T Cell Therapy for Patients with Diffuse Large B-cell Lymphoma in China: Evidence from a Cost-Effectiveness Analysis. Appl Health Econ Health Policy 21, 773–783 (2023). https://doi.org/10.1007/s40258-023-00817-5

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