The ZUMA-7 study (Efficacy of Axicabtagene Ciloleucel Compared to Standard of Care Therapy in Subjects With Relapsed/Refractory Diffuse Large B Cell Lymphoma) found that axicabtagene ciloleucel (axi-cel) improved event-free survival (EFS) compared with standard of care (SOC) salvage chemoimmunotherapy followed by autologous stem cell transplant in primary refractory/early relapsed diffuse large B-cell lymphoma (DLBCL). 

The cost-effectiveness of second-line axi-cel compared with SOC was evaluated using a Markov model (lifetime horizon) employing a variety of conceivable long-term outcomes for a hypothetical cohort of US people (mean age, 65 years) with primary refractory/early relapsed DLBCL. ZUMA-7 estimates for EFS and OS were used. With a willingness-to-pay (WTP) threshold of $150,000 per quality-adjusted life-year (QALY), outcome measures were presented as incremental cost-effectiveness ratios. 

At a WTP of $150,000 per QALY ($93 547 per QALY), axi-cel was cost-effective at a 5-year EFS of 35% with second-line axi-cel and 10% with SOC. If axi-5-year cel’s EFS was ≤ 26.4% or if it cost more than $972 061 at a WTP of $150 000, it was no longer cost-effective. At a WTP of $150,000, second-line axi-cel was the most cost-effective method in 73% of the 10,000 Monte Carlo iterations. Second-line axi-cel for aggressive relapsed/refractory DLBCL was more cost-effective than SOC at a WTP of $150,000 per QALY if the absolute benefit in EFS is sustained throughout time. 

However, the cost-effectiveness of the strategy was heavily reliant on long-term results. Even when administered in a high-risk group, second-line chimeric antigen receptor T-cell treatment would substantially increase healthcare costs in the United States (more than $1 billion annually). Chimeric antigen receptor T-cell treatment must be made more inexpensive before it may be used in many parts of the world.