CAR T-cell Therapy for Diffuse Large B-cell Lymphoma in Canada: A Cost-Utility Analysis

Area of Science:

• Oncology
• Health Economics
• Pharmacoeconomics

Background:

• Chimeric antigen receptor (CAR) T-cell therapy represents a significant advancement in oncology, offering potential cures for hematologic malignancies.
• The high cost of CAR T-cell therapies presents funding challenges for healthcare systems, necessitating rigorous cost-effectiveness evaluations.
• Tisagenlecleucel is a CAR T-cell therapy used for relapsed/refractory diffuse large B-cell lymphoma (DLBCL).

Purpose of the Study:

• To evaluate the cost-effectiveness of tisagenlecleucel compared to salvage chemotherapy for adult patients with relapsed/refractory DLBCL in Canada.
• To incorporate updated survival data from the JULIET trial into the cost-effectiveness model.

Main Methods:

• An individual-simulated discrete event simulation model was developed to compare costs and quality-adjusted life-years (QALYs).
• Survival estimates were derived from clinical trials and retrospective analyses, with a 5-year progression-free survival assumption for long-term remission.
• A Canadian healthcare payer perspective was adopted, with outcomes modeled over a lifetime horizon, discounted at 1.5% annually.

Main Results:

• Tisagenlecleucel resulted in an additional cost of $503,417 and 2.48 additional QALYs compared to salvage chemotherapy.
• The incremental cost-effectiveness ratio (ICER) was calculated at $202,991 per QALY.
• At a willingness-to-pay threshold of $100,000/QALY, tisagenlecleucel demonstrated a 0% probability of being cost-effective.

Conclusions:

• At its current price, tisagenlecleucel is not a cost-effective treatment option for relapsed/refractory DLBCL in Canada.
• The study's findings are sensitive to assumptions regarding long-term survival and the price of CAR T-cell therapies.
• Real-world evidence is crucial for reducing uncertainty and improving future cost-effectiveness assessments of CAR T-cell therapies.