Cost effectiveness of mosunetuzumab and CAR-T cell therapy in relapsed/refractory follicular lymphoma

T cell redirecting therapies, including mosunetuzumab (mosun), axicabtagene ciloleucel (axi-cel), and tisagenlecleucel (tisa-cel), are FDA-approved for relapsed refractory follicular lymphoma (FL) in the 3rd line and beyond. There's no head-to-head clinical trial data to compare their effectiveness. These products differ in administration, hospitalization requirements, and toxicity profiles, impacting therapy selection. We developed a Markov model spanning one to 10 years from a US payer perspective, using parameters from clinical trials, quality utilities, and billing costs. Our base case analysis over 10 years showed that mosun provided $67,654 more Net Monetary Benefit (NMB) per patient than axi-cel and $111,709 more than tisa-cel. These findings suggest mosun is cost-effective at a $150,000 willingness-to-pay per QALY.