Pola-R-CHP (polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone) is provisionally cost-effective compared with R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone) for first-line treatment of diffuse large B-cell lymphoma (DLBCL); however, its cost-effectiveness is dependent on its long-term outcomes and the costs of subsequent chimeric antigen receptor T-cell therapy, according to research published in Blood.
Researchers used Markov modeling to evaluate the cost-effectiveness of pola-R-CHP versus R-CHOP in a hypothetical cohort of US adult patients with treatment-naïve DLBCL and mean age of 65 years.
Their model was based on data from the phase 3 POLARIX trial (ClinicalTrials.gov Identifier: NCT03274492), which randomized patients with treatment-naive DLBCL to receive 6 cycles of pola-R-CHP or R-CHOP. In 2021, the POLARIX investigators reported a 6.5% absolute improvement in the 2-year progression-free survival (PFS) (76.7% vs 70.2%; hazard ratio, 0.73; 95% CI, 0.57-0.95; P =.02), with no difference in safety or, thus far, overall survival (OS) using pola-R-CHP compared with R-CHOP.
In the present study, the investigators reported outcome measures in incremental cost-effectiveness ratios, with a willingness-to-pay threshold of $150,000 per quality-adjusted life-year (QALY).
The team reported pola-R-CHP was cost-effective at a willingness-to-pay threshold of $150,000 when assuming a 5-year PFS of 69.6% with pola-R-CHP and 62.7% with R-CHOP, translating to an incremental cost-effectiveness ratio of $84,308/QALY. However, they found pola-R-CHP was no longer cost-effective if its 5-year PFS was 66.1% or lower.
At the willingness-to-pay threshold of $150,000, the researchers found pola-R-CHP is cost-effective up to a cost of $276,312 and was the cost-effective strategy in 56.6% of the 10,000 Monte Carlo iterations.
“Assuming that PFS improvement with pola-R-CHP is maintained long-term (70% 5-year PFS), it was the cost-effective treatment at a WTP of $150 000/QALY compared with R-CHOP,” the researchers summarized in their report. “Its cost-effectiveness was highly dependent on the 5-year PFS and the reduction in the number of patients who need subsequent CAR-T therapy that is associated with substantial costs. Its cost-effectiveness was also dependent on a modeled long-term mortality-benefit with pola- R-CHP compared with R-CHOP, which has not yet been seen clinically due to the short follow-up of POLARIX.”
Limitations of the study included lack long-term outcome data for pola-R-CHP; inclusion of only direct, not indirect, health care costs; assessment of cost only from the health care perspective; use of data only from a prospective clinical trial (POLARIX excluded patients >80 years of age); lack of real-world data; and inability to model evolving therapies, such as bispecific T-cell engagers or other novel antibody-drug conjugates.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures.
Kambhampati S, Saumoy M, Schneider Y, et al. Cost-effectiveness of polatuzumab vedotin combined with chemoimmunotherapy in untreated diffuse large B-cell lymphoma. Blood. 2022;140(25):2697-2708. doi:10.1182/blood.2022016624
Tilly H, Morschhauser F, Sehn LH, et al. Polatuzumab vedotin in previously untreated diffuse large B-cell lymphoma. N Engl J Med. 2022;386(4):351-363. doi:10.1056/NEJMoa2115304