Abstract A22: Cost effectiveness of second line Axicabtagene ciloleucel in relapsed refractory diffuse large B-cell lymphoma

Abstract Background In patients with relapsed/refractory diffuse large B-cell lymphoma (RR-DLBCL), CAR T has been shown to be effective in patients with at least 2 prior lines of therapy. ZUMA-7 study demonstrated that axi-cel improved event free survival (EFS) compared to standard of care (SOC) salvage chemoimmunotherapy in primary refractory/early relapse DLBCL leading to its recent FDA approval in this setting. We evaluated the cost effectiveness of second line axi-cel. Methods We modeled a hypothetical cohort of US adults (mean age, 65 years) with primary refractory/early relapse DLBCL by developing a Markov model (20-year horizon) to model the cost-effectiveness of axi-cel in the second-line setting compared to SOC using a range of plausible long-term outcomes. EFS and OS were estimated from ZUMA-7. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150,000/quality-adjusted life-year (QALY). Results Assuming a 5-year EFS of 35% with second line axi-cel and 10% with SOC, axi-cel was cost-effective at a WTP of 100,000 and 150,000 ($93,547/QALY). Axi-cel was no longer cost effective if its 5-year EFS was 26.4% or lower. One-way sensitivity analysis demonstrated that second-line CAR T is cost effective up to a cost of $972,061 at a WTP of $150,000. Second-line axi-cel was the cost-effective strategy in 73% of the 10,000 Monte-Carlo iterations at a WTP of $150,000. Conclusions If the absolute benefit in EFS is maintained over time, second line axi-cel for aggressive RR-DLBCL is cost effective when compared to SOC at WTPs of $100,000 and $150,000/QALY. However, its cost effectiveness is highly dependent on long-term outcomes. Routine usage of second-line CAR T would add significantly to healthcare expenditures even when used in a high-risk subpopulation. Further reductions in cost of CAR T are needed. Citation Format: Swetha Kambhampati, Monica Saumoy, Yecheskel Schneider, Lihua E. Budde, Alexey Danilov, Matthew Mei, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Stephen Forman, Larry Kwak, Steven Rosen, Alex Herrera, Nikhil Thiruvengadam. Cost effectiveness of second line Axicabtagene ciloleucel in relapsed refractory diffuse large B-cell lymphoma [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A22.