Lisocabtagene maraleucel (liso-cel) may be cost-effective when compared with axicabtagene ciloleucel (axi-cel) in patients with Relapsed or Refractory (R/R) Large B-Cell Lymphoma (LBCL)from a commercial US payer perspective, providing similar quality-adjusted life-years at a lower cost, due to a favorable safety profile associated with liso-cel, according to a study presented at 2021 ASH Annual Meeting.

Although research has suggested that the chimeric antigen receptor (CAR) T cell therapy, axi-cel may be cost-effective when compared with salvage chemotherapy, liso-cel, a CD19-directed CAR T cell therapy, may have comparable survival and a better safety profile than axi-cel.

Christopher Parker, MSc, Bristol Myers Squibb, Uxbridge, United Kingdom, and colleagues wrote, “We developed an economic model assessing cost-effectiveness of liso-cel versus axi-cel for patients with R/R LBCL after 2 or more lines of therapy from a commercial United States payer perspective.”

Patients entered the economic model at leukapheresis, and were then stratified based on whether or not they received the CAR T cell infusion due to death or other reasons.

“The model used a partitioned survival approach to estimate health state occupancy (progression-free survival [PFS], progressive disease, and death) and calculate incremental cost-effectiveness ratios using life-years and quality-adjusted life-years (QALY) over a lifetime horizon,” wrote Mr Parker and colleagues. 

Data on overall survival (OS) and PFS were collected from TRANSCEND NHL 001 (TRANSCEND [NCT02631044]) for liso-cel and ZUMA-1 (NCT02348216) for axi-cel. Comparative efficacy (OS, PFS) and safety (adverse events [AE]) were estimated using matching-adjusted indirect comparison (MAIC).

Pretreatment (leukapheresis, bridging therapy, and lymphodepleting chemotherapy), acquisition and administration of CAR T-cell therapies and subsequent-line treatments, all-grade AE management, post-infusion hospitalization, monitoring, and end-of-life care were all considered costs in this analysis. 

Among the 99 patients who received liso-cel, 45% achieved improved 5-year survival, compared with 41% of patients receiving axi-cel. Results from the base case revealed that liso-cel produced nearly equivalent QALYs (0.02) when compared with axi-cel, and cost savings of $75,063. Liso-cel also was found to be safer, as it resulted in lower rates of cytokine release syndrome and neurological events compared with axi-cel, which was reflected in cost savings and QALY gains.

“In probabilistic sensitivity analyses, the probability that liso-cel was more effective and less costly than axi-cel was 52% and the probability that liso-cel was cost-effective at a threshold of $100,000 was 78%,” reported the authors, adding, “Key drivers of cost-effectiveness included the OS cure fraction and the percent of patients experiencing grade 3/4 AEs for axi-cel.”

“This analysis estimated that liso-cel is cost-effective compared with axi-cel from a commercial US payer perspective, generating similar QALYs at lower cost, partly owing to a favorable safety profile associated with liso-cel,” concluded Mr Parker and colleagues.

Parker C, Liu F, Degar K, et al. Cost-Effectiveness of Lisocabtagene Maraleucel (liso-cel) Versus Axicabtagene Ciloleucel (axi-cel) for Treatment of Relapsed or Refractory (R/R) Large B-Cell Lymphoma (LBCL). Presented at The ASH Annual Meeting and Exposition; December 11-14, 2021; Atlanta, GA and Virtual. Abstract 3003.