Health economic analysis of third-line interventions in diffuse large B-cell lymphomas in Germany: applying the efficiency frontier

Florian Jakobs; Julia Jeck; Paymon Ahmadi; Anna Kron; Florian Kron

doi:10.1186/s12962-022-00400-0

Health economic analysis of third-line interventions in diffuse large B-cell lymphomas in Germany: applying the efficiency frontier

Cost Eff Resour Alloc. 2022 Dec 12;20(1):67. doi: 10.1186/s12962-022-00400-0.

Authors

Florian Jakobs^{1

2}, Julia Jeck², Paymon Ahmadi³, Anna Kron^{2

4

5

6}, Florian Kron^{7

8

9

10}

Affiliations

¹ Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
² VITIS Healthcare Group, Cologne, Germany.
³ Faculty of Medicine and University Hospital Hamburg-Eppendorf, Center for Oncology, University of Hamburg, Hamburg, Germany.
⁴ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁵ National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Cologne, Germany.
⁶ Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany.
⁷ VITIS Healthcare Group, Cologne, Germany. florian.kron@uk-koeln.de.
⁸ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. florian.kron@uk-koeln.de.
⁹ Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany. florian.kron@uk-koeln.de.
¹⁰ FOM University of Applied Sciences, Essen, Germany. florian.kron@uk-koeln.de.

Abstract

Background: In the past decades, highly innovative treatments in the field of diffuse large B-cell lymphoma (DLBCL) became available in clinical practice. The aim of this study was to assess the cost-benefit relation of third-line interventions in DLBCL from a German payer perspective.

Methods: Clinical benefit of allogeneic stem cell transplantation (alloSCT), chimeric antigen receptor T cells therapy (CAR T) [tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel)] and best supportive care (BSC) was assessed in terms of median overall survival (median OS) derived from a systematic literature review in PubMed. Real-world treatment costs were retrieved from the university hospitals Cologne and Hamburg-Eppendorf. The cost-benefit relation was analysed using the efficiency frontier concept.

Results: Median OS varied from 6.3 months in BSC to 23.5 months in CAR T (axi-cel), while median real-world treatment costs ranged likewise widely from €26,918 in BSC to €340,458 in CAR T (axi-cel). Shown by the efficiency frontier, alloSCT and axi-cel were found as most efficient interventions.

Conclusion: The efficiency frontier supports the pricing of innovative therapies, such as third-line interventions in DLBCL, in relation to appropriate comparators. Yet, studies with longer follow-up periods are needed to include studies with unreached median OS and to reflect experiences gained with CAR T in clinical practice.

Keywords: Best supportive care; CAR T-cell therapy; DLBCL; Efficiency frontier; Stem cell transplantation.