Carey N, Leahy J, Trela-Larsen L, Mc Cullagh L, Barry M. Cost-utility and value of information analysis of tisagenlecleucel for relapsed/refractory diffuse large B-cell lymphoma in the Irish healthcare setting.
JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023;
11:2166375. [PMID:
36684853 PMCID:
PMC9858398 DOI:
10.1080/20016689.2023.2166375]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND
The evidence base of tisagenlecleucel is uncertain.
OBJECTIVE
To evaluate the cost-effectiveness of tisagenlecleucel. To conduct expected value of perfect information (EVPI) and partial EVPI (EVPPI) analyses.
STUDY DESIGN
A three-state partitioned survival model. A short-term decision tree partitioned patients in the tisagenlecleucel arm according to infusion status. Survival was extrapolated to 5 years; general population mortality with a standardised mortality ratio was then applied. EVPI and EVPPI were scaled up to population according to the incidence of the decision.
SETTING
Irish healthcare payer.
PARTICIPANTS
Patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL).
INTERVENTIONS
Tisagenlecleucel versus Salvage Chemotherapy (with or without haematopoietic stem cell transplant).
MAIN OUTCOME MEASURE
Incremental cost-effectiveness ratio (ICER). Population EVPI and EVPPI.
RESULTS
At list prices, the ICER was €119,509 per quality-adjusted life year (QALY) (incremental costs €218,092; incremental QALYs 1.82). Probability of cost-effectiveness, at a €45,000 per QALY threshold, was 0%. Population EVPI was €0.00. Population EVPI, at the price of tisagenlecleucel that reduced the ICER to €45,000 per QALY, was €3,989,438. Here, survival analysis had the highest population EVPPI (€1,128,053).
CONCLUSION
Tisagenlecleucel is not cost-effective, versus salvage chemotherapy (with or without haematopoietic stem cell transplant), for R/R DLBCL in Ireland. At list prices, further research to decrease decision uncertainty may not be of value.
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