CAR T not cost-effective as second-line therapy for diffuse large B-cell lymphoma at current prices, study finds

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Study Title: Second-Line Chimeric Antigen Receptor T-Cell Therapy in Diffuse Large B-Cell Lymphoma: A Cost-Effectiveness Analysis

Publication: Annals of Internal Medicine:

Dana-Farber Cancer Institute authors: Amar H. Kelkar, MD, MPH (first author); Edward R. Scheffer Cliff, MBBS, MPH; Caron A. Jacobson, MD; Gregory A. Abel, MD, MPH; Corey Cutler, MD, MPH (senior author); and Robert Redd, MS.


Chimeric antigen receptor T-cell therapy (CAR T) is an effective second-line treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL), but the price must be lowered substantially to be considered cost-effective, an analysis by Dana-Farber Cancer Institute researchers shows. Compared with salvage chemoimmunotherapy with autologous stem cell transplantation, the current standard of care for primary-refractory and early-relapsed (high-risk) DLBCL, CAR T offers superior event-free and overall survival. However, at list prices exceeding $400,000 per infusion, cost-effectiveness could be an issue. Based on data from several clinical trials, the Dana-Farber found that neither second-line CAR T treatment with axi-cel or liso-cel was cost-effective at a willingness-to-pay threshold of $200,000 per quality-adjusted life-year. Both survival and quality of life improved incrementally with CAR T, but the data show that its cost must be lowered substantially to enable cost-effectiveness. The researchers' budget impact analysis found that the U.S. health sector would spend an additional $6.8 billion over five years with CAR T as the new standard of care. According to the authors, these findings may be relevant to clinic and hospital administrators negotiating reimbursements, pharmaceutical companies balancing costs and profits, private and public insurers navigating negotiations, and policymakers seeking to rein in rising drug prices.

Impact: While CAR T-cell therapy has demonstrated effectiveness as a second-line treatment for diffuse large B-cell lymphoma, the price of the treatment needs to be lowered substantially to be cost-effective.

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CAR T-Cell Therapy
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Amar H. Kelkar, MD, MPH