The Cost Effectiveness of Axicabtagene Ciloleucel Versus Best Supportive Care in the Treatment of Adult Patients with Relapsed or Refractory Large B-Cell Lymphoma (LBCL) After Two or More Lines of Systemic Therapy in Canada

被引:3
作者
Hillis, Christopher [1 ]
Vicente, Colin [2 ]
Ball, Graeme [3 ]
机构
[1] McMaster Univ, Hamilton, ON, Canada
[2] PIVINA Consulting Inc, Mississauga, ON, Canada
[3] Gilead Sci Canada Inc, Mississauga, ON, Canada
关键词
R-CHOP; SALVAGE CHEMOTHERAPY; ELDERLY-PATIENTS; CANCER-PATIENTS; AXI-CEL; RITUXIMAB; OUTCOMES; TISAGENLECLEUCEL; TRANSPLANTATION; SURVIVAL;
D O I
10.1007/s40273-022-01169-z
中图分类号
F [经济];
学科分类号
02 ;
摘要
Background and Objective Axicabtagene ciloleucel (axi-cel) received marketing authorisation in Canada for the treatment of relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, and the clinical and economic value of axi-cel to patients and the healthcare system should be examined. The objective of this analysis is to determine, from societal and public healthcare payer perspectives, the cost effectiveness of axi-cel versus best supportive care for patients with relapsed or refractory large B-cell lymphoma in Canada. Methods A pharmacoeconomic model was developed and populated with clinical data derived from the ZUMA-1 and SCHOLAR-1 studies using a propensity score-matched comparison. A partitioned survival mixture-cure modelling approach was taken to characterise the potential curative effect of axi-cel therapy in large B-cell lymphoma. Healthcare resource utilisation and adverse event data were based on results from ZUMA-1, and utility values were derived from ZUMA-1 data supplemented with published literature. Costs (in 2021 Canadian dollars) were taken from publicly available Canadian cost databases and published literature. Benefits and costs were discounted at 1.5% per year, and sensitivity analyses were conducted to assess the robustness of the results. Results In the base case, axi-cel generated an incremental 6.2 life-years compared to best supportive care, corresponding to 4.6 additional quality-adjusted life-years, and was associated with $606,010 in additional costs. The incremental cost-utility ratio was $132,747 per quality-adjusted life-year gained compared with best supportive care from a societal perspective ($106,392 per quality-adjusted life-year gained from a public healthcare payer perspective). Key drivers of the analysis included progression-free survival and overall survival values for axi-cel. Conclusions The results of this analysis suggest that axi-cel may be considered a cost-effective allocation of resources compared with best supportive care for the treatment of adult patients with relapsed or refractory large B-cell lymphoma in Canada.
引用
收藏
页码:917 / 928
页数:12
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