Standard of Care More Likely to Be Cost-Effective Than CAR-T Therapy in DLBCL

Among patients with diffuse large B-cell lymphoma (DLBCL), novel therapies, such as chimeric antigen receptor (CAR) T-cell therapy, are unlikely to be cost-effective at current pricing in the United States or Canada, as compared with standard of care (SOC), according to research published in the Journal of Clinical Oncology.

DLBCL is the most common non-Hodgkin lymphoma subtype, and is typically treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) followed by autologous stem cell transplant in the case of relapse.

Recently, some trials have suggested that combination polatuzumab, rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) may improve progression-free survival over the SOC, R-CHOP, among some patients with DLBCL. Furthermore, 2 CAR-T therapies, axicabtagene ciloleucel (axi-cel) and lisocabtagene maraleucel (liso-cel), appeared to improve outcomes vs transplantation in a subset of patients with relapsed or refractory disease.

Driven largely by the high cost of polatuzumab and CAR-T therapy, however, these treatment options may lead to financial toxicity among some patients. For this study, which consisted of probabilistic analyses, researchers compared the cost-effectiveness of R-CHP and CAR-T cell therapy, alone or in combination, with SOC among patients with intermediate- or high-risk DLBCL.

Analysis of the 10,000 conducted simulations showed that SOC was likely to be more cost-effective than any combination of the newer therapies investigated. For example, adding R-CHP to SOC had an incremental cost-effectiveness ratio (ICER) of $546,956 per quality of life–adjusted life-year (QALY); this figure was $245,381 for Canadian dollars.

Furthermore, adding second-line CAR-T cell therapy to SOC had an ICER of $309,813 per QALY ($303,163 for Canadian dollars). Combining R-CHP and second-line CAR-T cell therapy with SOC, finally, had an ICER of $488,284 per QALY ($267,050 for Canadian dollars).

“Expert analysis from policymakers is required to determine the appropriateness of funding these therapies,” the authors wrote in their report.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Vijenthira A, Kuruvilla J, Crump M, Jain M, Prica A. Cost-effectiveness analysis of frontline polatuzumab-rituximab, cyclophosphamide, doxorubicin, and prednisone and/or second-line chimeric antigen receptor T-cell therapy versus standard of care for treatment of patients with intermediate- to high-risk dif. J Clin Oncol. Published online October 31, 2022. doi:10.1200/JCO.22.00478