Liso-cel CAR-T cost-effective as second-line treatment for advanced lymphoma

ByMatthew Shinkle

Fact checked byMindy Valcarcel, MS

Key takeaways:

Liso-cel’s price increased by more than $35,000 dollars between 2022 and 2023.
The CAR T-cell therapy’s ICER continued to be under the $150,000 per QALY threshold for cost- effectiveness in the U.S.

Researchers found lisocabtagene maraleucel to be a cost-effective second-line treatment option for patients with relapsed or refractory diffuse large B-cell lymphoma, study findings published in Blood Advances showed.

The analysis is a first-of-its-kind assessment of the chimeric antigen receptor T-cell therapy’s cost-effectiveness while also incorporating health care expenses, societal productivity losses and patient quality of life, according to researchers.

Cost-effectiveness of liso-cel as second-line therapy for DLBCL infographic — Data derived from Choe JH, et al. *Blood Adv*. 2023;doi:10.1182/bloodadvances.2023011793.

“In our study, we incorporated the often-overlooked societal costs associated with cancer treatment, which are typically neglected in cost-effectiveness analyses that focus solely on the health care sector-related expenses," Mohamed Abou-el-Enein, MD, PhD, MSPH, associate professor of medicine at University of Southern California's Keck School of Medicine, said in a press release.

“Cancer treatments can diminish quality of life, causing work absences and challenges in managing everyday activities, especially among the elderly,” he added. “Treatments that improve quality of life not only benefit the patient but also reduce these broader societal costs, which is an important aspect of our cost-effectiveness evaluation."

Background and methodology

Lisocabtagene maraleucel (Breyanzi, Bristol Myers Squibb) — also known as liso-cel — received FDA approval in 2022 for use as second-line therapy for adults with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who experienced early disease relapse following first-line chemo-immunotherapy.

The TRANSFORM study had previously shown improvements in event-free survival for this patient population with treatment of liso-cel over standard of care; however, due to the high price associated with CAR T-cell therapy, researchers noted the need for a cost-effectiveness study to determine the potential economic viability of its implementation as a potential new standard of care.

Researchers employed a partitioned survival model using standard parametric functions over a lifetime horizon to assess the cost-effectiveness of the CAR-T over platinum-based chemotherapy prior to autologous hematopoietic stem cell transplantation.

The study used data from the TRANSFORM and TRANSCEND trials — as well as other established literature and public datasets — to calculate the incremental cost-effectiveness ratio (ICER).

Life-years gained and quality-adjusted life years (QALYs) served as the primary outcomes for the study.

Results, next steps

Using a representative cohort of 60-year-old U.S. adults, researchers noted liso-cel’s ICER to be $99,669 per QALY from a health care sector perspective and $68,212 per QALY from a societal perspective, thus confirming its cost-effectiveness at the $100,000 per QALY threshold, according to researchers.

Researchers also noted that liso-cel’s QALY can sometimes surpass the $100,000 threshold under certain circumstances, but that it remains within the acceptable range in the United States of $150,000 per QALY.

Patients treated with liso-cel had an average life expectancy of 5.34 years and gained 3.64 QALYs, compared with the 2.47 years and 1.62 QALYs when treated with standard care.

The study is the first to analyze cost-effectiveness of this CAR-T as a second-line therapy for this specific patient population, highlighting the significant challenge certain therapies face in achieving widespread use due to high acquisition costs (liso-cel increased in price from $410,300 to $447,227 between 2022 and 2023) and limited long-term data.

“This study demonstrates that CAR T-cell therapy is worth considering as a second line treatment for [relapsed or refractory] DLBCL,” Abou-el-Enein said in the release. “When deciding on what therapies to use in clinical practice, I think it is important that we do not shy away from these therapies solely because of their list price. We must keep our patients front and center in these decisions and continue to have conversations about how we can lower the price of CAR T cells and increase patient access to this life-saving treatment.”