Treatment with chimeric antigen receptor (CAR) T-cell therapies in B-cell cancers, like certain types of lymphoma and leukemia, is associated with an increase in quality-adjusted and overall survival compared to alternative chemotherapies, according to a new report.
The report, titled “Chimeric Antigen Receptor T-Cell Therapy for B- Cell Cancers: Effectiveness and Value,” was prepared by the Institute for Clinical and Economic Review (ICER) for CTAF (California Technology Assessment Forum), a core program of ICER.
ICER is a nonprofit research organization that analyzes medical evidence to help clinicians, insurance companies, pharmacies, and other stakeholders apply current evidence to improve patient outcomes and control costs.
In this study, a panel of experts focused on the economic implications of CAR T-cell therapy for the treatment of B-cell malignant cancers.
CAR-T therapy involves the genetic engineering of a patient’s own T- cells to target proteins that are present on the surface of cancer cells.
Kymriah (tisagenlecleucel) and Yescarta (axicabtagene ciloleucel) are the only approved CAR-T therapies to date. But despite their proven effectiveness, their price tags are set at $475,000 and $373,000 per treatment.
ICER focused on the economic and patient impact of these therapies in people with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL) and relapsed or refractory aggresive B-cell non-Hodgkin’s lymphoma — the indications for which they are currently approved.
Researchers used a measure called QALY — or quality-adjusted life year — to measure the cost-effectiveness of these therapies.
The long-term cost-effectiveness of Kymriah compared to clofarabine — a standard chemotherapy for patients with B-ALL — was $45,871 per increase in QALY. Similarly, the cost-effectiveness of Yescarta compared to standard chemotherapy was $136,078 per increase in QALY. Both of these treatments are within the acceptable cost-effectiveness thresholds.
“The findings of our analysis suggest that the CAR-T therapies of focus for this review provide gains in quality-adjusted and overall survival over alternative chemotherapies. With the evidence available at this time, these therapies seem to be priced in alignment with clinical benefits over a lifetime time horizon,” the investigators wrote.
But they caution that while Yescarta is cost-effective in the long-term, it can be quite expensive in the short-term and even exceed the threshold for the annual budget.
In fact, only 38% of patients who are eligible for this treatment could be treated in a year before the cost of the treatment crossed ICER’s $915 million annual budget threshold. The long-term cost-effectiveness can also change once these treatments are approved for more indications.
“Based on current evidence, both therapies appear to be priced in alignment with their clinical value, but there are potential short-term affordability concerns — for [Yescarts] under its current indication, and for both treatments should they receive future approvals for broader patient populations,” Dan Ollendorf, PhD, ICER’s chief scientific officer, said in a press release.
Ollendorf suggests that due to the many potential therapies in development, stakeholders should start to “develop payment and delivery systems that can ensure timely patient access, manage short-term affordability for expensive one-time treatments, and continue to reward the innovation that brings these new treatments to market.”