Investigators have found that chimeric antigen receptor (CAR) T-cell therapy may be an effective but unaffordable second-line treatment option for patients with relapsed diffuse large B-cell lymphoma (DLBCL), according to a recent study published by Kelkar et al in the Annals of Internal Medicine.
Compared with salvage chemoimmunotherapy with autologous stem cell transplantation—the current standard of care for primary-refractory and early-relapsed DLBCL—CAR T-cell therapy may offer superior event-free and overall survival. However, the treatment has list prices exceeding $400,000 per infusion.
Study Details and Conclusions
In the new study, the investigators examined the data from several clinical trials and discovered that both survival and quality of life improved incrementally with CAR T-cell therapy. Nonetheless, the investigators found that second-line CAR T-cell therapy with either axicabtagene ciloleucel or lisocabtagene maraleucel was not cost-effective at a willingness-to-pay threshold of $200,000 per quality-adjusted life-year. Their budget impact analysis found that the U.S. health sector would spend an additional $6.8 billion over 5 years if CAR T-cell therapy became the new standard of care for DLBCL.
The investigators emphasized that their new 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. Although CAR T-cell therapy has demonstrated efficacy as a second-line treatment in this patient population, the investigators concluded that the price of the treatment must be lowered substantially to be considered cost-effective.
Disclosure: For full disclosures of the study authors, visit acpjournals.org.
