Examining the Cost-Effectiveness of a Treatment for Patients With DLBCL

A recent study found that tisagenlecleucel is a cost-effective treatment option for relapsed or refractory diffuse large B-cell lymphoma. According to the study findings, which were published online in Clinical Therapeutics, the estimated cost-effective prices ranged from $612,270 to up to $1.5 million.  

For the study, the researchers aimed to “assess the cost-effectiveness and cost-effective price of tisagenlecleucel, a novel, effective chimeric antigen receptor T-cell therapy, versus salvage chemotherapy for the treatment of relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) using a willingness-to-pay threshold of $150,000 per quality-adjusted life year (QALY) gained from a US third-party payer's perspective.” 

The study authors developed a three-state responder-based partitioned survival model, including progression-free survival (PFS), progressive disease, and death, with a lifetime horizon and 3% annual discount rate. They also estimated the overall survival (OS) and PFS survival of tisagenlecleucel for patients with and without an overall response.  

“The median OS was 11.1 months in all tisagenlecleucel-treated patients but not reached for responders; no progression or death occurred among responders since month 22 of treatment,” the study authors explained. “For tisagenlecleucel nonresponders and [salvage chemotherapy], survival was based on standard parametric models until month 60, and the survival of DLBCL long-term survivors thereafter. Costs and utilities were from the literature; utilities depended on health states and were used to estimate QALYs.” 

According to the findings, there were 3.35 QALYs gained among patients receiving tisagenlecleucel vs salvage chemotherapy. Further, using the wholesale acquisition cost of $373,000 for tisagenlecleucel, the incremental costs per QALY gained vs salvage chemotherapy were $78,652.  

The researchers determined that the cost-effective price of tisagenlecleucel in all treated patients was $612,270 at the willingness-to-pay threshold of $150,000. Additionally, there was an increase of 7.82 and 9.34 QALYs for tisagenlecleucel overall response and complete response versus SC. The cost-effective prices for these responses were $1,281,456 and $1,551,974, respectively. 

“Tisagenlecleucel is a cost-effective treatment versus SC for r/r DLBCL from the perspective of a US third-party payer,” the study authors concluded.  

Reference: 

Qi CZ, Bollu V, Yang H, Dalal A, Zhang S, Zhang J. Cost-effectiveness analysis of tisagenlecleucel for the treatment of patients with relapsed or refractory diffuse large b-cell lymphoma in the united states [published online ahead of print, 2021 Aug 8]. Clin Ther. 2021;S0149-2918(21)00242-3. doi:10.1016/j.clinthera.2021.06.011