Advances in therapy · 2026
Cost-Effectiveness of Lisocabtagene Maraleucel Versus Axicabtagene Ciloleucel as Second-Line Treatment for Large B Cell Lymphoma in the United States.
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Deger Kristen A, Liu Fei Fei, Klijn Sven L, Franco-Villalobos Conrado, Sorensen Sonja V, Lunning Matthew
Аннотация
INTRODUCTION: This study evaluated the cost-effectiveness of lisocabtagene maraleucel (liso-cel) versus axicabtagene ciloleucel (axi-cel) as a second-line treatment for patients with primary refractory or early relapsed transplant-eligible large B cell lymphoma (LBCL) from a US commercial third-party payer perspective.
METHODS: A partitioned survival model captured the event-free, post-event, and death states to estimate incremental cost-effectiveness ratios (ICERs) from cost and quality-adjusted life-years (QALYs) over a lifetime horizon. Mixture cure modeling was employed to extrapolate event-free survival (EFS) and overall survival (OS) beyond the trial follow-up period using data from the TRANSFORM and ZUMA-7 studies. The comparative treatment effect of liso-cel versus axi-cel was estimated using the Bucher method for indirect treatment comparisons, leveraging standard of care as a common comparator across both trials. Health state utility estimates and disutilities due to adverse events (AE) were derived from TRANSFORM EQ-5D-5L data and supplemented with published sources. The model incorporated costs associated with chimeric antigen receptor T cell therapy pre-treatment, treatment acquisition and administration (inpatient and outpatient), subsequent treatment, AE management, hospitalization after infusion, monitoring, and end-of-life care based on standard US sources.
RESULTS: Liso-cel was projected to result in additional QALYs of 0.31, at a lower cost than axi-cel (incremental cost of - $9398). The cost of liso-cel was offset by lower costs associated with AE management (- $11,109), chimeric antigen receptor T cell administration (- $15,074), and subsequent treatment (- $2864). The main driver of results was the OS cure probability.
CONCLUSION: Liso-cel as a second-line LBCL treatment was estimated to be cost-effective compared with axi-cel, as informed by pivotal trials, from a US commercial third-party payer perspective. Patients treated with liso-cel were estimated to gain slightly more QALYs at a lower cost.
TRIAL REGISTRATION: NCT03575351 (TRANSFORM), NCT03391466 (ZUMA-7).
METHODS: A partitioned survival model captured the event-free, post-event, and death states to estimate incremental cost-effectiveness ratios (ICERs) from cost and quality-adjusted life-years (QALYs) over a lifetime horizon. Mixture cure modeling was employed to extrapolate event-free survival (EFS) and overall survival (OS) beyond the trial follow-up period using data from the TRANSFORM and ZUMA-7 studies. The comparative treatment effect of liso-cel versus axi-cel was estimated using the Bucher method for indirect treatment comparisons, leveraging standard of care as a common comparator across both trials. Health state utility estimates and disutilities due to adverse events (AE) were derived from TRANSFORM EQ-5D-5L data and supplemented with published sources. The model incorporated costs associated with chimeric antigen receptor T cell therapy pre-treatment, treatment acquisition and administration (inpatient and outpatient), subsequent treatment, AE management, hospitalization after infusion, monitoring, and end-of-life care based on standard US sources.
RESULTS: Liso-cel was projected to result in additional QALYs of 0.31, at a lower cost than axi-cel (incremental cost of - $9398). The cost of liso-cel was offset by lower costs associated with AE management (- $11,109), chimeric antigen receptor T cell administration (- $15,074), and subsequent treatment (- $2864). The main driver of results was the OS cure probability.
CONCLUSION: Liso-cel as a second-line LBCL treatment was estimated to be cost-effective compared with axi-cel, as informed by pivotal trials, from a US commercial third-party payer perspective. Patients treated with liso-cel were estimated to gain slightly more QALYs at a lower cost.
TRIAL REGISTRATION: NCT03575351 (TRANSFORM), NCT03391466 (ZUMA-7).