The Cost-Effectiveness of CAR-T Therapies for Diffuse Large B-Cell Lymphoma: A Critical Examination

Chimeric antigen receptor T-cell (CAR-T) therapies, such as axicabtagene ciloleucel (axi-cel) and lisocabtagene maraleucel (liso-cel), have been hailed as breakthroughs in the treatment of various cancers. However, a recent study published in the Annals of Internal Medicine has raised questions about their cost-effectiveness for patients with diffuse large B-cell lymphoma (DLBCL).

Study Findings: CAR-T Therapies vs. Standard Treatments

The study conducted a comprehensive cost-effectiveness analysis of second-line CAR-T therapy versus standard treatments, including salvage chemoimmunotherapy and consolidative autologous stem cell transplantation (ASCT). The results revealed that neither axi-cel nor liso-cel was cost-effective compared to these standard treatments. The increase in median overall survival with axi-cel and liso-cel was four and one months, respectively. Meanwhile, the incremental cost-effectiveness ratios were found to be $684,225 and $1,171,909 per quality-adjusted life year (QALY) for axi-cel and liso-cel, respectively.

Implications for Health Care Spending

With the current pricing, implementing CAR-T therapies in high-risk patients would significantly increase U.S. health care spending. The study estimated an additional expenditure of about $6.8 billion over five years. To be deemed cost-effective, with a willingness-to-pay threshold of $200,000 per QALY, the cost of CAR-T therapies would need to be reduced significantly. Specifically, the cost would need to be lowered to $321,123 and $313,730 for axi-cel and liso-cel, respectively.

Investigations into CAR-T Therapies

As the debate over cost-effectiveness continues, CAR-T therapies are also under investigation by the FDA. This follows reports of T-cell malignancies in patients who received these treatments. The investigation is primarily focused on B-cell maturation agent (BCMA)- or CD19-directed autologous CAR T-cell immunotherapies. While the results of this investigation are yet to be released, it adds another layer of consideration in the use of these therapies.

A Future Perspective

Despite the current cost-effectiveness concerns, researchers are continually exploring new diagnostic and treatment approaches for hematologic malignancies. CAR-T therapies represent a vital part of these efforts. Researchers from the Hackensack Meridian John Theurer Cancer Center, for instance, are presenting new treatments and updates on advanced approaches such as CAR T-cell therapies. These potentially promise to treat diseases more effectively than standard therapies.

While the cost-effectiveness of CAR-T therapies is currently under scrutiny, the landscape of cancer treatment is continually evolving. As more research is conducted and more data becomes available, the place of CAR-T therapies in the treatment of DLBCL and other cancers will become clearer. The hope is that with more research and development, the cost of these therapies will decrease, making them more accessible to the patients who need them most.