In a study reported in the Journal of Clinical Oncology, Vijenthira et al found that front-line polatuzumab vedotin-piiq plus rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP), second-line chimeric antigen receptor (CAR) T-cell therapy, or the combination would not be likely to be considered cost-effective compared with the standard of care for the treatment of patients with newly diagnosed, intermediate- to high-risk diffuse large B-cell lymphoma (DLBCL).
As stated by the investigators, “Recent studies of polatuzumab vedotin and CD19 CAR T-cell therapy have shown significant improvements in progression-free survival over standard of care for patients with DLBCL. However, they are costly, and it is unclear whether these strategies, alone or combined, are cost-effective over standard of care.”
Study Details
A Markov model (10,000 simulations) was used to compare four treatment strategies:
- Polatuzumab vedotin plus R-CHP with second-line CAR T-cell therapy for early relapse (< 12 months)
- Polatuzumab vedotin plus R-CHP plus second-line salvage therapy with/without autologous stem-cell transplantation (ASCT)
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) plus second-line CAR T-cell therapy for early relapse
- The standard of care; R-CHOP plus second-line salvage therapy with or without ASCT.
Data on clinical outcomes were estimated from clinical trial data. Lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated from U.S. and Canadian payer perspectives. The willingness-to-pay threshold was defined as $150,000 U.S. dollars (USD) or Canadian dollars (CAD)/QALY using 2021 dollars.
Key Findings
In the probabilistic analyses, each strategy from 1 to 3 was incrementally more effective but more costly than the previous strategy. Specific findings included:
- Polatuzumab vedotin plus R-CHP plus second-line salvage therapy had an ICER of $546,956 USD/QALY and $245,381 CAD/QALY vs standard of care.
- R-CHOP plus second-line CAR T-cell therapy had an ICER of $309,813 USD/QALY and $303,163 CAD/QALY vs standard of care.
- Polatuzumab vedotin plus R-CHP and second-line CAR T-cell therapy had an ICER of $488,284 USD/QALY and $267,050 CAD/QALY vs standard of care.
The investigators concluded, “Given uncertain incremental benefits in long-term survival and high costs, neither polatuzumab vedotin plus R-CHP frontline, CAR-T second-line, nor a combination are likely to be cost-effective in the United States or Canada at current pricing compared with the standard of care.”
Anca Prica, MD, MSc, of Princess Margaret Cancer Centre, Toronto, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
