Cost effectiveness analysis of CAR-T cell therapy for patients with relapsed/refractory multiple myeloma in China

Figures & data

Figure 1. Simplified diagram of Markov model structure.

Figure 2. Fitted survival curves of Clita-cel, Idel-cel and Salvage Chemotherapy.

Table 1. Key input parameters.

Model input	Value	Distribution	Sources/Notes
Proportion of treatment continuation
Ide-cel	91.4%	Beta	Munshi NC, 2021^12
Cilta-cel	85.8%	Beta	Martin T, 2022^13
Probability of CRS (grade 3 or higher)
Ide-cel	5.5%	Beta	Munshi NC, 2021^12
Cilta-cel	5.2%	Beta	Martin T, 2022^13
Probability of Neurotoxicity (grade 3 or higher)
Ide-cel	3.1%	Beta	Munshi NC, 2021^12
Cilta-cel	12.3%	Beta	Martin T, 2022^13
Probability of second CAR-T treatment
Ide-cel	21.9%	Beta	Munshi NC, 2021^12
Cilta-cel	3.1%	Beta	Martin T, 2022^13
SMR	2.2	Beta	Binder M,2022^27
Cost (US $)
Ide-cel	193,023	Gamma	Assumption
Cilta-cel	193,023	Gamma	Assumption
Drug acquisition of salvage chemotherapy	11,173	Gamma	Collected by authors
Base cost during CAR-T treatment	11,444	Gamma	Collected by authors
Monthly base cost during salvage chemotherapy	3,387	Gamma	Collected by authors
Monthly follow-up cost
First year	495	Gamma	Collected by authors
First to third year	248	Gamma	Assumption
Third to fifth year	124	Gamma	Assumption
CRS	4,364	Gamma	Collected by authors
Neurotoxicity	7,421	Gamma	Collected by authors
Total cost for second CAR-T treatment	9,740	Gamma	Collected by authors
Salvage chemotherapy after progression	4,253	Gamma	Collected by authors
Palliative therapy	3,039	Gamma	Li Z, 2019^30
Utility
PFS	0.87	Beta	Collected by authors
PD	0.72	Beta	Collected by authors
Clinical cure	0.94	Beta	Yang Z, 2018^33
Disutility
Chemotherapy	0.25	Beta	Li X, 2018^32 and experts’ opinion
CAR-T	0.21	Beta	Collected by authors

Abbreviations. SMR, standardized mortality ratio; CRS, cytokine release syndrome; BMTC-FAHZUSM, Bone Marrow Transplantation Center, the First Affiliated Hospital of Zhejiang University School of Medicine; PFS, progression-free state; PD, progression disease.

Table 2. Summary of base case and scenario analysis results.

Strategy	Cost ($)	Life years	QALYs	incrCost ($)	incrQALYs	ICER ($/QALY)
Base case
Salvage chemotherapy	76,512	1.19	0.92	Ref.	Ref.	Ref.
Ide-cel	217,205	2.51	2.11	140,693	1.19	118,229
Cilta-cel	196,318	4.76	4.23	119,806	3.31	36,195
Scenario analyses that starting age is changed from 60 to 55 in the model
Salvage chemotherapy	76,566	1.19	0.92	Ref.	Ref.	Ref.
Ide-cel	217,598	2.56	2.16	141,032	1.24	113,735
Cilta-cel	196,847	5.21	4.65	120,281	3.73	32,247
Scenario analyses that partitioned survival model was adopted
Salvage chemotherapy	82,997	1.24	0.96	Ref.	Ref.	Ref.
Ide-cel	224,771	2.58	2.17	141,774	1.23	117,169
Cilta-cel	205,583	4.84	4.32	122,586	3.36	36,484

Figure 3. Tornado diagram for univariable sensitivity analysis. (a) Ide-cel. (b) Cilta-cel.

Figure 4. Cost-effectiveness plane. (a) Ide-cel. (b) Cilta-cel.

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