Axicabtagene ciloleucel compared to standard of care in Canadian patients with relapsed or refractory large B-cell lymphoma: a cost-effectiveness analysis of the ZUMA-7 trial

In the pivotal ZUMA-7 trial, second-line (2L) treatment with axicabtagene ciloleucel (axi-cel) had superior clinical outcomes compared to standard of care (SOC; salvage chemoimmunotherapy followed by high-dose therapy and autologous stem cell transplant in responders) in patients with large B-cell lymphoma (LBCL) who were refractory or relapsed (r/r) within 12 months of completion of frontline therapy. The aim of this analysis was to evaluate the cost-effectiveness of axi-cel compared to SOC for 2L LBCL in Canada. A 3-health state partitioned-survival model was used to estimate the cost-effectiveness of axi-cel vs. SOC from a Canadian healthcare system perspective. Clinical outcomes were informed by ZUMA-7. The model calculated expected quality-adjusted life years (QALYs), total costs, and the incremental cost-effectiveness ratio (ICER). Over a lifetime horizon, the model estimated a total of 9.48 and 7.25 QALYs, and total costs of $569,168 and $337,906 for axi-cel and SOC, respectively, resulting in an ICER of $103,810/QALY. When adjusting for the substantial proportion of patients in the SOC arm who received cellular therapy as subsequent treatment, the ICER was reduced to $78,555/QALY. Treatment with axi-cel in 2L is a cost-effective option that addresses an important unmet clinical need for Canadian patients with r/r LBCL.