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Cost-effectiveness analysis of axicabtagene ciloleucel vs. salvage chemotherapy for relapsed or refractory adult diffuse large B-cell lymphoma in China

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Abstract

Purpose

Axicabtagene ciloleucel (Axi-Cel, 2 × 106 CAR-T cells/kg, single intravenous injection) is a chimeric antigen receptor cell immunotherapy that exhibits favorable clinical efficacy and safety in patients with relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL). However, this treatment is expensive in China. This study aimed to evaluate the cost-effectiveness of Axi-Cel versus salvage chemotherapy for the treatment of R/R DLBCL from the perspective of the Chinese healthcare system.

Methods

A decision analysis model containing a short-term decision tree and long-term semi-Markov partitioned survival model was developed. The time horizon was 40 years and the period from 10 to 40 years was included in sensitivity analysis. The model was developed based on data from the ZUMA-1 and SCHOLAR-1 trials. Life years, quality-adjusted life years (QALYs), overall costs, and the incremental cost-effectiveness ratio (ICER) were estimated at a willingness to pay (WTP) threshold of US $31,320 per QALY, which is three times the gross domestic product per capita.

Results

The base case analysis revealed that treatment with Axi-Cel is associated with an increased overall cost of US $175,380 and improved effectiveness of 3.43 LYs and 2.61 QALYs compared to salvage chemotherapy, leading to an ICER of US $51,190 per LY and US $67,250 per QALY. The developed model is sensitive to the discount rate, utility of progression-free survival (PFS), and cost of Axi-Cel. The ICER of Axi-Cel was greater than the WTP threshold in the sensitivity and scenario analyses. To achieve cost-effectiveness, the price of Axi-Cel must be reduced by 59.19% to US $71,000.

Conclusion

At its current price, Axi-Cel is not likely to be a cost-effective option compared to salvage chemotherapy for adult patients with R/R DLBCL.

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Data availability

Data were derived from published literature data and local data.

Code availability

TreeAge Pro 2020, GetData Graph Digitizer 2.0, R studio.

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Funding

This study was funded by grants from the National Natural Science Foundation of China (grant number 71804025) and from Science and Technology Department of Fujian Province of China (grant number 2021R0053) to Ms Li.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China

    Na Li, Bin Zheng, Hongfu Cai & Maobai Liu

  2. The School of Pharmacy, Fujian Medical University, Fuzhou, China

    Na Li, Bin Zheng, Hongfu Cai & Maobai Liu

  3. Department of Hematology, Fujian Provincial Key Laboratory On Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China

    Ting Yang, Yunda Hong & Jianda Hu

Authors
  1. Na Li
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  2. Bin Zheng
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  3. Hongfu Cai
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  4. Ting Yang
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  5. Yunda Hong
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  6. Maobai Liu
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  7. Jianda Hu
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Contributions

NL had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: NL, ML, JH. Acquisition, analysis, or interpretation of data: NL, ML, HC, BZ, YH, TY, JH. Drafting of the manuscript: NL. Critical revision of the manuscript for important intellectual content: ML, BZ, TY, JH. Statistical analysis: NL, HC. Obtained funding: NL. Administrative, technical, or material support: ML, JH. Supervision: ML, JH.

Corresponding authors

Correspondence to Maobai Liu or Jianda Hu.

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As this study did not involve patient participation, it did not require a review by the institutional review committee or exemption or approval by the ethics committee.

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Li, N., Zheng, B., Cai, H. et al. Cost-effectiveness analysis of axicabtagene ciloleucel vs. salvage chemotherapy for relapsed or refractory adult diffuse large B-cell lymphoma in China. Support Care Cancer 30, 6113–6121 (2022). https://doi.org/10.1007/s00520-022-07041-2

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  • DOI: https://doi.org/10.1007/s00520-022-07041-2

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