Cost-utility and Value of Information Analysis of Tisagenlecleucel for Relapsed/refractory Diffuse Large B-cell Lymphoma in the Irish Healthcare Setting

Overview

Journal J Mark Access Health Policy

Publisher MDPI

Specialty Public Health

Date 2023 Jan 23

PMID 36684853

Authors

Niamh Carey

Joy Leahy

Lea Trela-Larsen

Laura Mc Cullagh

Michael Barry

Affiliations

Soon will be listed here.

Abstract

Background: The evidence base of tisagenlecleucel is uncertain.

Objective: To evaluate the cost-effectiveness of tisagenlecleucel. To conduct expected value of perfect information (EVPI) and partial EVPI (EVPPI) analyses.

Study Design: A three-state partitioned survival model. A short-term decision tree partitioned patients in the tisagenlecleucel arm according to infusion status. Survival was extrapolated to 5 years; general population mortality with a standardised mortality ratio was then applied. EVPI and EVPPI were scaled up to population according to the incidence of the decision.

Setting: Irish healthcare payer.

Participants: Patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL).

Interventions: Tisagenlecleucel versus Salvage Chemotherapy (with or without haematopoietic stem cell transplant).

Main Outcome Measure: Incremental cost-effectiveness ratio (ICER). Population EVPI and EVPPI.

Results: At list prices, the ICER was €119,509 per quality-adjusted life year (QALY) (incremental costs €218,092; incremental QALYs 1.82). Probability of cost-effectiveness, at a €45,000 per QALY threshold, was 0%. Population EVPI was €0.00. Population EVPI, at the price of tisagenlecleucel that reduced the ICER to €45,000 per QALY, was €3,989,438. Here, survival analysis had the highest population EVPPI (€1,128,053).

Conclusion: Tisagenlecleucel is not cost-effective, versus salvage chemotherapy (with or without haematopoietic stem cell transplant), for R/R DLBCL in Ireland. At list prices, further research to decrease decision uncertainty may not be of value.

Citing Articles

Economic evaluation of anti-CD19 CAR T-cell pathway for large B-cell lymphomas in the real-life setting: the experience of an Italian hub center in the first three years of activity.

Di Staso R, Casadei B, Gentilini M, Guadagnuolo S, Pellegrini C, Broccoli A Ann Hematol. 2024; 103(7):2499-2509.

PMID: 38695872 PMC: 11224113. DOI: 10.1007/s00277-024-05766-0.

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