Chimeric antigen receptor T-cell (CAR-T) therapy may be a cost-effective approach for the treatment of adults with diffuse large B-cell lymphoma (DLBCL), depending on the long-term outcomes of these patients, findings from a study published in the Journal of Clinical Oncology have shown.

Diffuse large B-cell lymphoma is the most common subtype of lymphoma, with approximately two-thirds of patients achieving long-term remission following first-line treatment with chemoimmunotherapy. Tisagenlecleucel and axicabtagene ciloleucel are 2 potentially curative anti-CD19 CAR-T therapies approved for the treatment of relapsed/refractory DLBCL in adult patients who have received 2 or more lines of systemic therapy; these CAR-T therapies have also been studied in the setting of relapse after hematopoietic stem cell transplantation (HSCT) in patients with this disease. 2,3

Related Articles

As the cost of both of these CAR-T cell therapies is very high, their cost-effectiveness is an important factor for consideration when weighing treatment decisions for these patients. Another option for patients with relapsed/refractory DLBCL is salvage chemoimmunotherapy, often followed by HSCT in those achieving a response to treatment.

Continue Reading

In this study, the cost effectiveness of each of the CAR-T therapies was independently compared with the cost effectiveness of a mix of 4 standard regimens of salvage chemoimmunotherapy plus HSCT in a fraction of patients achieving a response to treatment using models based on data from large randomized clinical trials of patients with relapsed/refractory DLBCL. The 2 CAR-T therapies were not directly compared due to a lack of data from head-to-head randomized trials. Mean life expectancies associated with the different treatments were assessed based on rates of 5-year progression-free survival (PFS). Patient outcome measures used in this study included life years, lifetime costs, quality-adjusted life years (QALYs), and incremental cost per QALY gained.

Patients treated with axicabtagene ciloleucel had mean life expectancies of 11.8 years, 10.0 years, and 9.1 years with 5-year PFS rates of 40%, 30% and 20%, respectively. Those treated with tisagenlecleucel had mean life expectancies of 8.3 years, 7.0 years, and 5.90 years with 5-year PFS rates of 35%, 25%, and 15%, respectively. For comparison, the mean life expectancy of patients treated with salvage chemoimmunotherapy was 3.7 years.

The costs associated with these treatments were $638,000 to $655,000 for axicabtagene ciloleucel; $521,000 to $529,000 for tisagenlecleucel; and $145,000 to $195,000 for salvage chemoimmunotherapy.

“At current prices, the cost effectiveness of axicabtagene ciloleucel and tisagenlecleucel were dependent on their long-term outcomes,” the study authors noted.

For example, patients treated with axicabtagene ciloleucel with an associated 5-year PFS rate of 40% had an additional 3.72 QALYs at a cost of $129,000/QALY gained compared with salvage chemoimmunotherapy. When the 5-year PFS rates was 30% these values dropped to 2.96 QALYs at a cost of $159,000/QALY. Similarly, for patients treated with tisagenlecleucel compared with salvage chemoimmunotherapy, an additional 2.14 QALYs at a cost of $168,000 were gained when the 5-year PFS rate was 35%, dropping to 1.58 QALYs at a cost of $223,000 when the associated 5-year PFS rate was 25%.

Both CAR-T therapies meet a less than $150,000/QALY threshold, at 2018 prices. However, this depends on long-term outcomes compared with chemoimmunotherapy and HSCT, which are uncertain. Widespread adoption would substantially increase healthcare costs for treating non-Hodgkin lymphoma, the study authors noted. “Price reductions or payment for initial response would improve cost effectiveness, even with modest long-term outcomes,” they concluded.


  1. Lin JK, Muffly LS, Spinner MA, et al. Cost effectiveness of chimeric antigen receptor T-cell therapy in multiply relapsed or refractory adult large B-cell lymphoma [published online June 3, 2019]. J Clin Oncol. doi: 10.1200/JCO.18.02079
  2. Kymriah™ [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2018.
  3. Yescarta® [package insert]. Santa Monica, CA: Kite Pharma Inc; 2019.

This article originally appeared on Oncology Nurse Advisor