An updated cost-effectiveness analysis of axicabtagene ciloleucel in second-line large B-cell lymphoma patients in the United States

Figures & data

Table 1. Model inputs.

Model input	Point estimate	Source
Health state utility values
Axi-cel, on-treatment	0.740	Roth^19
SOC, on-treatment	0.673	Roth^19
Pre-event, off-treatment	0.823	Sullivan^20
Post-event	0.710	NICE [TA567]^21
Direct costs^a
Axi-cel acquisition*	$462,000	List price
Lisocabtagene maraleucel acquisition*	$447,227	RED BOOK^22
Tisagenlecleucel acquisition*	$427,048	RED BOOK^22
CAR T-cell administration^b	$74,068	Liu^23
Leukapheresis, cost*	$1,190	RED BOOK^22; CMS^24
Bridging/conditioning chemotherapy	$6,317	RED BOOK^22; CMS^24
R-ICE	$8,357	RED BOOK^22; CMS^24
R-ESHAP	$8,502	RED BOOK^22; CMS^24
R-GDP	$8,165	RED BOOK^22; CMS^24
R-DHAP	$7,696	RED BOOK^22; CMS^24
HDT	$10,424	RED BOOK^22; CMS^24
Chemotherapy inpatient administration	$3,696	Dasta^25
Chemotherapy outpatient administration	$1,183	CMS^24
Stem cell harvest	$79,530	Pelletier^26
Auto-SCT	$45,172	Pelletier^26
Auto-SCT follow-up^c	$14,157	Pelletier^26
Allo-SCT	$360,702	Broder^27
Allo-SCT follow-up^d	$318,185	Broder^27
End-of-life care	$19,696	Kutikova^28
Pre-event resource utilization	$2,151	Perales^3
Post-event resource utilization^e	$2,013
BIM inputs
Axi-cel market uptake^f		Data on file
Year 1	2–6%
Year 2	9–13%
Year 3	12–16%
Year 4	14–18%
Year 5	16–20%
Incidence of LBCL	54/1,000,000	SEER^29
Primary refractory disease	15%	Sehn^30
Relapsed disease	25%	Sehn^30
Proportion relapsed within 12 months	70%	Maurer^31
Proportion intended for auto-SCT	50%	Friedberg^32

* Denotes an input updated in the updated analysis. ^aAll costs reported in 2023 USD. ^bInpatient administration costs include the management of all AEs with the exception of B-cell aplasia. ^cAuto-SCT follow-up applied monthly up to a maximum of 24 months. ^dOnly as a subsequent treatment; allo-SCT follow-up applied as a one-off cost. ^ePost-event resource utilization reverts to $0 at 5 years. ^fSOC is assumed to account for the remainder of the market share. Abbreviations. allo-SCT, allogeneic stem cell transplant; auto-SCT, autologous stem cell transplant; BIM, budget impact model; CT, computerized tomography; GP, general practitioner; HDT, high-dose therapy; LDH, lactate dehydrogenase; R-DHAP, rituximab, dexamethasone, cytarabine, cisplatin; R-ESHAP, rituximab, etoposide, cytarabine, cisplatin; R-GDP, rituximab, gemcitabine, dexamethasone, cisplatin; R-ICE, rituximab, ifosfamide, carboplatin, etoposide.

Figure 1. Time to event plots for axi-cel (a), SOC (B) and modelled extrapolated survival (C). Abbreviations. EFS, event-free survival; KM, Kaplan Meier; OS, overall survival; SOC, standard of care; TTNT, time to next treatment.

Figure 2. Subsequent treatments and total cost for SOC (top) and axi-cel (bottom) by category.

Table 2. Base case cost-effectiveness results (discounted, 2023 USD).

	Axi-cel	SOC	Difference
LYs	9.35	7.61	1.74
Event-free	6.60	3.06	3.54
Post-event	2.75	4.56	−1.80
QALYs	7.23	5.60	1.63
Event-free	5.33	2.44	2.88
Post-event	1.91	3.16	−1.25
Total costs	$769,890	$609,981	$159,909
2L treatment costs	$511,398	$95,906	$415,492
3L + CAR T treatment costs	$6,951	$309,359	−$302,408
3L + other treatment costs	$160,340	$107,689	$52,651
Disease management	$73,490	$63,470	$10,021
Other costs^a	$17,710	$33,558	−$15,848
ICER, axi-cel vs SOC			$98,040

^a Includes cost of managing adverse events and terminal care. Abbreviations. LYs, life years; QALYs, quality-adjusted life years; SOC, standard of care; USD, United States dollars.

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