In a groundbreaking study published in the journal Cancers, researchers explored the cost-effectiveness of axicabtagene ciloleucel (axi-cel) versus the conventional salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem-cell transplantation (HDT+ASCT) for patients with relapsed or refractory large B-cell lymphoma (R/R LBCL). The findings could significantly influence market access strategies for cutting-edge cancer treatments, providing valuable insights for healthcare policymakers.
Study Methodology and Approach
The research utilized a partitioned survival mixture-cure model to assess the costs, life years gained (LYG), and quality-adjusted life years (QALYs) over a patient’s lifetime. The ZUMA-7 study provided critical data on overall survival, event-free survival, and time to subsequent treatment with both axi-cel and HDT+ASCT. Incorporating a 3% discount rate to align with standard economic evaluations, the study ensured robust and comparable results.
The total costs, based on 2022 Euros, included numerous factors such as drug acquisition and administration, ASCT, subsequent treatment, and management of the disease and adverse events. These costs were meticulously gathered from local databases and existing literature, ensuring a comprehensive evaluation of economic impact.
Results and Economic Implications
Axi-cel demonstrated superior outcomes compared to HDT+ASCT, with higher life years gained per patient (10.00 vs. 8.28 LYG/patient) and greater QALYs gained per patient (7.85 vs. 6.04 QALY/patient). Despite its higher lifetime total costs (343,581 EUR/patient for axi-cel vs. 257,994 EUR/patient for HDT+ASCT), axi-cel’s incremental cost-effectiveness ratio (ICER) was found to be 49,627 EUR/LYG, and the incremental cost-utility ratio (ICUR) was 47,309 EUR/QALY.
The sensitivity analyses further validated the model’s robustness, reinforcing the potential of axi-cel as a cost-effective treatment option. These findings are crucial for market access considerations, as they highlight the long-term economic benefits of adopting axi-cel despite its initial higher cost.
Key Inferences
Based on the study’s findings, several key inferences can be drawn:
- Axi-cel offers improved patient outcomes in terms of life years and quality of life compared to HDT+ASCT.
- Despite higher upfront costs, axi-cel’s long-term benefits justify its use from a cost-effectiveness perspective.
- Market access strategies should consider the long-term economic and health benefits of axi-cel, potentially influencing policy decisions.
The study concludes that axi-cel represents a potentially cost-effective alternative to HDT+ASCT for treating R/R DLBCL in Spain. This could pave the way for broader acceptance and integration of advanced therapies in healthcare systems, ultimately benefiting patients and stakeholders involved.
Original Article:
Cancers (Basel). 2024 Jun 22;16(13):2301. doi: 10.3390/cancers16132301.
ABSTRACT
PURPOSE: To estimate the cost-effectiveness of axi-cel vs. salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem-cell transplantation (HDT+ASCT) for responders to second-line treatment for relapsed/refractory (R/R) large B-cell lymphoma (LBCL).
METHODS: A partitioned survival mixture-cure model comprising three health states was used to estimate the costs, life years gained (LYG), and quality-adjusted life years (QALYs) accumulated over a lifetime horizon. Overall survival, event-free survival, and time to the next treatment with axi-cel and HDT+ASCT were derived from the ZUMA-7 study. The total costs (EUR, 2022) included drug acquisition and administration, ASCT, subsequent treatment, disease and adverse event management, and palliative care. The unitary costs were derived from local databases and the literature. A 3% discount rate was applied to the costs and outcomes.
RESULTS: Compared with HDT+ASCT, axi-cel provided higher LYG per patient (10.00 vs. 8.28 LYG/patient) and greater QALYs gained per patient (7.85 vs. 6.04 QALY/patient). The lifetime total costs were 343,581 EUR/patient with axi-cel vs. 257,994 EUR/patient with IQT+ASCT. The incremental cost-effectiveness ratio of axi-cel vs. HDT+ASCT was 49,627 EUR/LYG, and the incremental cost-utility ratio was 47,309 EUR/QALY. Sensitivity analyses confirmed the robustness of the model.
CONCLUSION: Axi-cel is a potentially cost-effective alternative to HDT+ASCT for the treatment of R/R DLBCL in Spain.
PMID:39001364 | DOI:10.3390/cancers16132301
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