Is it a chimera? A systematic review of the economic evaluations of CAR-T cell therapy - an update

ABSTRACT

Introduction

The new class of chimeric antigen receptor T-cell has emboldened health-care professionals and patients for a more effective treatment of hematological malignancies, indicatively lymphoma, acute lymphoblastic leukemia, and myeloma. Nevertheless, their burgeoning procurement costs comprise a litmus stress for health systems across the globe. In this context, this systematic review aims to update the current body of evidence assessing CAR-T economic evaluations and elucidate their financial efficiency.

Areas covered

A systematic review of the economic evaluations of tisagenlecleucel, axicabtagene ciloleucel, idecabtagene vicleucel, lisocabtagene maraleucel, ciltacabtagene autoleucel and brexucabtagene autoleucel was performed.

Expert opinion

The updated results corroborated the previously reported favorable cost–effectiveness ratio of CAR-T. They also pointed out differences among CAR-T agents. However, their budget impact emerges as a significant barrier in the reimbursement process. Any proposed Managed Entry Agreement must integrate the ingrained uncertainty of long-term efficacy and precede reimbursement decisions.

KEYWORDS:

• CAR-T
• tisagenlecleucel
• axicabtagene
• idecabtagene vicleucel
• lisocabtagene maraleucel
• brexucabtagene autoleucel
• KTE-X19
• economic evaluation
• ciltacabtagene autoleucel

Article highlights

• Previous systematic studies illustrated a favorable cost-effectiveness profile of CAR-T cell

• The economic studies rely heavily on data extrapolation, given the void in long-term data.

• This is interlaced with substantial uncertainty

• Certain differences between the CAR-T categories were posited

• Their administration should be governed by MEA

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.