Cost-Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Adults with Relapsed or Refractory Follicular Lymphoma.

Follicular lymphoma (FL) is traditionally considered treatable but incurable. In March 2021, the U.S. Food and Drug Administration approved the use of chimeric antigen receptor T-cell (CAR-T) therapy for use in patients with relapsed or refractory (R/R) FL after two or more lines of therapy. Priced at $373,000, CAR-T is potentially curative, and its cost-effectiveness compared to other modern R/R FL treatment strategies is unknown. We developed a Markov model to assess the cost-effectiveness of third-line CAR-T versus standard of care (SOC) therapies in adults with R/R FL. We estimated progression rates for patients receiving CAR-T and SOC therapies from the ZUMA-5 trial and the LEO CReWE study, respectively. We calculated costs, discounted life years (LYs), quality adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) of CAR-T versus SOC therapies with a willingness-to-pay threshold of $150,000/QALY. Our analysis was conducted from a U.S. payer perspective over a lifetime horizon. In our base-case model, the cost of the CAR-T strategy was $731,682 compared to $458,490 for SOC therapies. However, CAR-T was associated with incremental clinical benefit of 1.50 QALYs, resulting in an ICER of $182,127/QALY. Our model was most sensitive to the utilities associated with CAR-T remission and third-line SOC therapies and to the total upfront CAR-T cost. Under current pricing, CAR-T is unlikely to be cost-effective in unselected FL patients in the third-line setting. Both randomized clinical trials and longer-term clinical follow up can help clarify the benefits of CAR-T and optimal sequencing in patients with FL.