Cost-effectiveness of axicabtagene ciloleucel versus tisagenlecleucel for the treatment of 3L + relapsed/refractory large B-cell lymphoma in the United States: incorporating longer survival results

Figures & data

Table 1. Model inputs.

Variable	Base case	Distribution for sensitivity analysis	Reference
Patient baseline characteristics
Female, %	64.5%	NA	^12
Mean age, years	56	NA	^25
Mean body weight, kg	78.7	Normal	^25
Mean body surface area, m^2	1.92	Normal	^25
Utilities
Pre-progression: on CAR T-cell therapy treatment (applied in 1^st month)	0.740	Beta	^26
Pre-progression: off treatment (≤24 months since model entry)	0.782	Beta	^26
Pre-progression: off treatment (>24 months since model entry)	0.820	Beta	^26
Post-progression	0.390	Beta	^27
CAR T-cell therapy drug acquisition, apheresis, and administration costs (one-off)
Drug WAC: axi-cel	$462,000.00	Gamma	^28
Drug WAC: tisa-cel	$399,110.00	Gamma	^29
Apheresis (CPT: 36511): axi-cel and tisa-cel	$110.39	Gamma	^30
Administration (CPT: 96413): axi-cel and tisa-cel	$140.16	Gamma	^30
CAR T-cell therapy conditioning chemotherapy and monitoring costs (one-off)
Number of doses for axi-cel: fludarabine, 30 mg/m^2	3	NA	^11
Number of doses for axi-cel: cyclophosphamide, 500 mg/m^2	3	NA	^11
Number of doses for tisa-cel: fludarabine, 25 mg/m^2	3	NA	^12
Number of doses for tisa-cel: cyclophosphamide, 250 mg/m^2	3	NA	^12
Drug WAC: fludarabine IV per 50 mg vial	$94.50	NA	^29
Drug WAC: cyclophosphamide IV per 500 mg vial	$366.25	NA	^29
Drug administration cost: fludarabine or cyclophosphamide (CPT: 96413)	$140.16	Gamma	^30
Monitoring: PET/CT (1 × event^22; cost per event) (CPT 78816)	$116.62	Gamma	^31
Monitoring: office visit (4 × events^22; cost per event) (CPT 99215)	$183.07	Gamma	^31
Adverse event cost (one-off)
Axi-cel
Patients treated for B-cell aplasia with IVIG	8.0%	Beta	^22
Number of IVIG infusions	12	NA	^22
Tisa-cel
Patients treated for B-cell aplasia with IVIG	18.3%	Beta	^24
Number of IVIG infusions	1.43	NA	^24
B-cell aplasia treatment cost
Immunoglobulin acquisition cost (per package with ten 100 mg vials)	$132.50	NA	^32^,^30
Immunoglobulin administration cost (CPT: 96413)	$140.16	Gamma	^31
Stem cell transplant cost (one-off)
Patients receiving SCT post-relapse or refractory
Axi-cel	7.9%	Beta	Kite Pharma, data on file
Tisa-cel	5.4%	Beta	^12
Cost of SCT (per procedure)	$337,192.94	Gamma	^32^,^34
Hospitalization cost (one-off)
Hospitalization rate (axi-cel)	100%	Beta	Assumption
Hospitalization rate (tisa-cel)	93.9%	Beta	^35
LOS: non-ICU days (axi-cel)	13.9	Gamma	^22 a
LOS: ICU days (axi-cel)	3.7	Gamma	^22 b
LOS: non-ICU days (tisa-cel)	27.89	Gamma	^35
LOS: ICU days (tisa-cel)	0.90	Gamma	^35
Cost per day: non-ICU	$3,706.02	Gamma	^32^,^36
Cost per day: ICU	$6,406.66	Gamma	^32^,^37
Care costs
Routine care costs per month	$1,991	Gamma	^32^,^38
End of life (3 months^22, one-off; cost per month)	$20,896	Gamma	^32^,^39

Abbreviations. CAR, chimeric antigen receptor; CPT, Current Procedural Terminology; CT, computed tomography; ICU, intensive care unit; IVIG, intravenous immunoglobulin; LoS, length of stay; NA, not applicable; PET, positron emission tomography; SCT, stem cell transplantation; WAC, wholesale acquisition cost.

^aEstimated as: average hospital days (17.6) multiplied by the proportion of non-ICU stay (79%).

^bEstimated as: average hospital days (17.6) multiplied by the proportion of ICU stay (21%).

Table 2. Base case results.

	Axi-cel	Tisa-cel	Incremental
Total undiscounted LYs	13.26	9.38	3.89
Pre-progression	12.87	7.84	5.03
Post-progression	0.39	1.53	−1.14
Total discounted costs	$692,140	$641,955	$50,185
CAR T-cell therapy treatment-related costs	$469,284	$402,515	$66,769
Drug acquisition	$462,000	$399,110	$62,890
Apheresis	$110	$110	$0
Drug administration	$140	$140	$0
Conditioning chemotherapy	$858	$854	$3
Monitoring	$849	$849	$0
Adverse event	$5,327	$1,452	$3,875
Stem cell transplant	$26,708	$18,227	$8,482
Hospitalization	$75,208	$102,470	−$27,263
Disease management costs	$74,511	$67,370	$7,141
Pre-progression	$65,435	$41,216	$24,220
Post-progression	$9,076	$26,155	−$17,079
Terminal care costs	$46,429	$51,373	−$4,944
Total discounted QALYs	7.35	4.84	2.51
Pre-progression	7.20	4.41	2.79
Post-progression	0.15	0.43	−0.28
Total discounted LYs	9.22	6.51	2.71
Pre-progression	8.84	5.42	3.42
Post-progression	0.38	1.09	−0.71
Costs per QALY gained			$19,994
Costs per LY gained			$18,551

Abbreviations. CAR, chimeric antigen receptor; LY, life year; QALY, quality-adjusted life year.

Figure 1. Deterministic sensitivity analysis – tornado plot of parameter impact on cost per QALY gained. Negative values of cost per QALY gained from the tornado plot should be interpreted with caution as a negative cost per QALY gained may be caused by negative incremental costs (a good outcome) or negative incremental QALYs (a bad outcome). Abbreviations. AE, adverse event; ICU, intensive care unit; PFS, progression-free survival; QALY, quality-adjusted life year.

Figure 2. Cost-effectiveness plane. Abbreviation. QALY, quality adjusted life year.

Figure 3. Cost-effectiveness acceptability curve. Abbreviation. QALY, quality-adjusted life year.

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