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Cost-Effectiveness of Tisagenlecleucel in Paediatric Acute Lymphoblastic Leukaemia (pALL) and Adult Diffuse Large B-Cell Lymphoma (DLBCL) in Switzerland

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Abstract

Introduction

The purpose of the present analysis was to explore the cost-effectiveness of tisagenlecleucel in relapsed or refractory (r/r) paediatric acute lymphoblastic leukaemia (pALL) and r/r adult diffuse large B-cell lymphoma (DLBCL) in Switzerland against a range of historical standard-of-care treatments.

Methods

Two cost-utility models were constructed for the two licensed indications using similar methodologies but indication-specific data. Clinical efficacy data were based on pooled analyses of clinical trials for tisagenlecleucel (pALL: ELIANA, ENSIGN, B2101J; DLBCL: JULIET, NCT02030834) and published data for comparator treatments. Treatment effects were compared based on matching-adjusted indirect comparison (MAIC) analyses. Four clinical lymphoma and leukaemia experts provided Switzerland-specific input regarding comparators, diagnostic and therapeutic procedures, clinical evidence and costs, which were used to inform the models. The base case analysis reflected the perspective of the Swiss mandatory health insurance system. Deterministic, probabilistic and scenario analyses were carried out to explore the robustness of results.

Results

The base case analysis resulted in incremental costs of CHF 31,961–CHF 36,419 per quality-adjusted life year (QALY) gained for pALL across the different comparators and CHF 113,179 for DLBCL (1 CHF = 1.09 USD). Incremental costs per life-year gained ranged between CHF 33,906–CHF 97,399 across the two indications. Including productivity gains, tisagenlecleucel was shown to be dominant (more effective and less costly) over all the comparators for pALL and to result in incremental costs per life-year gained of CHF 57,324 for DLBCL.

Conclusion

Using hypothetical willingness-to-pay thresholds of CHF 100,000–150,000 per QALY gained, the present analysis has shown tisagenlecleucel to be a cost-effective treatment option in pALL and DLBCL.

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Acknowledgements

Funding

The work (including the journal’s Rapid Service Fee) was funded by Novartis Pharma Schweiz AG, Rotkreuz, Switzerland.

Medical Writing/Editorial Assistance

Medical writing/ editorial assistance was funded by Novartis Pharma Schweiz AG, Rotkreuz, Switzerland. The manuscript was conceptualized by Elisabeth Brock, (HealthEcon AG) and Maziar Moradi-Lakeh (Optimax Access LLC). The manuscript was drafted and finalized by Elisabeth Brock (HealthEcon AG) based on the feedback received by all co-authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

The contributions of the individual authors were as follows: Maziar Moradi-Lakeh (data collection, analysis, writing), Mohsen Yaghoubi (analysis, writing), Patrick Seitz (data collection, writing), Mehdi Javanbakht (analysis), Elisabeth Brock (data collection, writing).

Prior Publication

The economic model presented here is based on efficacy data derived from previously published clinical trials for both intervention and comparators [31, 35,36,37, 45,46,47,48,49,50,51,52, 54, 55]. The economic model, Swiss input data and model results have not been published or presented previously.

Disclosures

The work conducted by Maziar Moradi-Lakeh (Optimax Access LLC), Mehdi Javanbakht (Optimax Access Ltd.), Mohsen Yaghoubi (now: Mercer University; at the time of conducting the work presented in this manuscript: Canada OptimaxAccess Consulting) and Elisabeth Brock (HealthEcon AG) was funded by Novartis Pharma Schweiz AG. Patrick Seitz is an employee of Novartis Pharma Schweiz AG.

Compliance with Ethics Guidelines

This work is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Clinical expert interviews were conducted, documented, transcribed and analysed in line with accepted international scientific practice. We would like to express our sincere thanks to the clinical experts who shared their knowledge about current treatment practice in Switzerland and last but not least to all the participants of the published clinical trials which formed the basis for the efficacy data used in the economic model.

Data Availability

The datasets generated during and/ or analyzed during the current study are available from the corresponding author on reasonable request. The majority of the data generated or analyzed during this study are included in the supplementary information files.

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Correspondence to Elisabeth Brock.

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Moradi-Lakeh, M., Yaghoubi, M., Seitz, P. et al. Cost-Effectiveness of Tisagenlecleucel in Paediatric Acute Lymphoblastic Leukaemia (pALL) and Adult Diffuse Large B-Cell Lymphoma (DLBCL) in Switzerland. Adv Ther 38, 3427–3443 (2021). https://doi.org/10.1007/s12325-021-01767-x

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  • DOI: https://doi.org/10.1007/s12325-021-01767-x

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