Cost–effectiveness analysis 3L of axicabtagene ciloleucel vs tisagenlecleucel and lisocabtagene maraleucel in Japan

<b>Aim:</b> Cost–effectiveness analysis (CEA) was performed to compare axicabtagene ciloleucel (axi-cel) with tisagenlecleucel (tisa-cel) and lisocabtagene (liso-cel) for treatment of relapsed or refractory large B-cell lymphoma in adult patients after ≥2 lines of therapy in Japan. <b>Materials &amp; methods:</b> Cost–effectiveness analysis was conducted using the partition survival mixture cure model based on the ZUMA-1 trial and adjusted to the JULIET and TRANSCEND trials using matching-adjusted indirect comparisons. <b>Results &amp; conclusion:</b> Axi-cel was associated with greater incremental life years (3.13 and 2.85) and incremental quality-adjusted life-years (2.65 and 2.24), thus generated lower incremental direct medical costs (-$976.29 [-¥137,657] and -$242.00 [-¥34,122]), compared with tisa-cel and liso-cel. Axi-cel was cost-effective option compared with tisa-cel and liso-cel from a Japanese payer's perspective. This is the first study comparing cost–effectiveness among different CD19-targeted chimeric antigen receptor T-cell therapies in Japan. Axi-cel was associated with additional life years (LYs) and quality-adjusted life years (QALYs) gained and decreased costs compared with either tisa-cel or liso-cel, demonstrating that it is a cost-effective treatment option among currently available chimeric antigen receptor T-cell therapies in Japan which may improve life expectancy. In the base case, axicabtagene ciloleucel (axi-cel) was found to be highly cost-effective versus tisagenlecleucel (tisa-cel) and lisocabtagene (liso-cel). Axi-cel was associated with more LYs (3.13 and 2.85) and QALYs (2.65 and 2.24), and lower direct medical costs (-$976.29 [-¥137,657] and -$242.00 [-¥34,122]), compared with tisa-cel and liso-cel, respectively. The gain in discounted LYs and QALYs was predominantly attributable to pre-progression survival status for axi-cel. Compared with tisa-cel and liso-cel, patients treated with axi-cel experienced a longer progression-free state and improved QALYs (discounted LYs: 3.36 and 2.66; QALYs 2.75 and 2.17, respectively). The analyses showed that patients who received axi-cel incurred lower total discounted costs by -$976.29 (-¥137,657) and -$242.00 (-¥34,122) versus tisa-cel and liso-cel ($280,875.73 vs $281,852.02 and $280,673.52 vs $280,915.52), respectively. These reductions in total discounted costs for axi-cel were driven by apheresis costs and end-of-life care costs versus tisa-cel, and by end-of-life care costs versus liso-cel, respectively.