Martín García-Sancho Alejandro, Presa María, Pardo Carlos, Martín-Escudero Victoria, Oyagüez Itziar, Ortiz-Maldonado Valentín
Haematology Department, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERONC, Hospital Universitario de Salamanca, University of Salamanca, 37007 Salamanca, Spain.
Health Economics Department, Pharmacoeconomics & Outcomes Research Iberia (PORIB), 28224 Madrid, Spain.
Cancers (Basel). 2024 Jun 22;16(13):2301. doi: 10.3390/cancers16132301.
To estimate the cost-effectiveness of axi-cel vs. salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem-cell transplantation (HDT+ASCT) for responders to second-line treatment for relapsed/refractory (R/R) large B-cell lymphoma (LBCL).
A partitioned survival mixture-cure model comprising three health states was used to estimate the costs, life years gained (LYG), and quality-adjusted life years (QALYs) accumulated over a lifetime horizon. Overall survival, event-free survival, and time to the next treatment with axi-cel and HDT+ASCT were derived from the ZUMA-7 study. The total costs (EUR, 2022) included drug acquisition and administration, ASCT, subsequent treatment, disease and adverse event management, and palliative care. The unitary costs were derived from local databases and the literature. A 3% discount rate was applied to the costs and outcomes.
Compared with HDT+ASCT, axi-cel provided higher LYG per patient (10.00 vs. 8.28 LYG/patient) and greater QALYs gained per patient (7.85 vs. 6.04 QALY/patient). The lifetime total costs were 343,581 EUR/patient with axi-cel vs. 257,994 EUR/patient with IQT+ASCT. The incremental cost-effectiveness ratio of axi-cel vs. HDT+ASCT was 49,627 EUR/LYG, and the incremental cost-utility ratio was 47,309 EUR/QALY. Sensitivity analyses confirmed the robustness of the model.
Axi-cel is a potentially cost-effective alternative to HDT+ASCT for the treatment of R/R DLBCL in Spain.
评估axi-cel与挽救性免疫化疗联合大剂量化疗及自体干细胞移植（HDT+ASCT）用于复发/难治性（R/R）大B细胞淋巴瘤（LBCL）二线治疗缓解者的成本效益。
采用包含三种健康状态的分区生存混合治愈模型，以估计终生范围内累积的成本、获得的生命年（LYG）和质量调整生命年（QALY）。axi-cel和HDT+ASCT的总生存、无事件生存以及下次治疗时间来自ZUMA-7研究。总成本（2022年欧元）包括药物采购与给药、ASCT、后续治疗、疾病及不良事件管理以及姑息治疗。单位成本来自本地数据库和文献。对成本和结果应用3%的贴现率。
与HDT+ASCT相比，axi-cel每位患者获得更高的LYG（10.00 vs. 8.28 LYG/患者）和更多的QALY（7.85 vs. 6.04 QALY/患者）。axi-cel的终生总成本为343,581欧元/患者，而HDT+ASCT为257,994欧元/患者。axi-cel与HDT+ASCT相比的增量成本效益比为49,627欧元/LYG，增量成本效用比为47,309欧元/QALY。敏感性分析证实了模型的稳健性。
在西班牙，对于R/R DLBCL的治疗，axi-cel是HDT+ASCT潜在的成本效益替代方案。
