Examining the Cost-Effectiveness of DLBCL Treatment

The immunotherapy drug tisagenlecleucel is associated with an “exceedingly high” incremental cost-effectiveness ratio for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who failed two or more lines of systemic therapies, according to a cost utility analysis that took a Singapore health care payer perspective. Researchers published their findings online in the Journal of Medical Economics. 

“Patients with relapsed or refractory DLBCL have limited treatment options and poor prognoses,” wrote the Singapore-based research team. “Tisagenlecleucel, a chimeric antigen receptor (CAR) T-cell therapy, has shown early promise in improving survival outcomes, but at a high upfront cost.” 

Researchers investigated the cost-effectiveness of tisagenlecleucel compared with salvage chemotherapy for patients with relapsed or refractory DLBCL who failed at least two lines of systemic therapies. To do so, they developed a hybrid decision tree and three-state partitioned survival model. Survival curves from two studies were extrapolated over a 15-year time horizon to estimate underlying progression-free survival and overall survival. Direct costs were sourced from healthcare facilities in Singapore.  

According to the analysis, tisagenlecleucel was associated with a base-case incremental cost-effectiveness ratio (ICER) US$508,530 per quality adjusted life year gained, and US$320,200 per life year gained, compared with salvage chemotherapy. 

Even under favorable assumptions, the ICERs remained high, researchers noted. Substantial price reductions would be required to reduce the ICER. 

For patients with relapsed or refractory DLBCL who failed prior lines of systemic therapies, tisagenlecleucel “is unlikely to represent good use of healthcare resources,” researchers concluded. “Comparative clinical evidence from the ongoing trials might provide more insight into future evaluations.” 

—Jolynn Tumolo 

Reference: 

Cher BP, Gan KY, Aziz MIA, et al. Cost utility analysis of tisagenlecleucel vs salvage chemotherapy in the treatment of relapsed/refractory diffuse large B-cell lymphoma from Singapore's healthcare system perspective [published online ahead of print, 2020 Aug 25]. J Med Econ. 2020;1-9. doi:10.1080/13696998.2020.1808981