Economic Evaluations of Chimeric Antigen Receptor T-Cell Therapies for Hematologic and Solid Malignancies: A Systematic Review

Kednapa Thavorn; Emily Rose Thompson; Srishti Kumar; Aliisa Heiskanen; Anubhav Agarwal; Harold Atkins; Risa Shorr; Terry Hawrysh; Kelvin Kar-Wing Chan; Justin Presseau; Daniel A Ollendorf; Ian D Graham; Jeremy M Grimshaw; Manoj Mathew Lalu; Surapon Nochaiwong; Dean A Fergusson; Brian Hutton; Doug Coyle; Natasha Kekre

doi:10.1016/j.jval.2024.04.004

Economic Evaluations of Chimeric Antigen Receptor T-Cell Therapies for Hematologic and Solid Malignancies: A Systematic Review

Value Health. 2024 Apr 17:S1098-3015(24)02336-2. doi: 10.1016/j.jval.2024.04.004. Online ahead of print.

Authors

Kednapa Thavorn¹, Emily Rose Thompson², Srishti Kumar², Aliisa Heiskanen³, Anubhav Agarwal³, Harold Atkins⁴, Risa Shorr², Terry Hawrysh⁵, Kelvin Kar-Wing Chan⁶, Justin Presseau³, Daniel A Ollendorf⁷, Ian D Graham³, Jeremy M Grimshaw⁸, Manoj Mathew Lalu⁹, Surapon Nochaiwong¹⁰, Dean A Fergusson³, Brian Hutton³, Doug Coyle¹¹, Natasha Kekre¹²

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand. Electronic address: kthavorn@ohri.ca.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁴ Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Transplant and Cell Therapy Program, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
⁵ Patient Partner, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada.
⁶ Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
⁷ Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Institute for Clinical and Economic Review, Boston, MA, USA.
⁸ Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
¹¹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹² Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Transplant and Cell Therapy Program, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.

PMID: 38641057
DOI: 10.1016/j.jval.2024.04.004

Abstract

Objectives: This study aimed to systematically review evidence on the cost-effectiveness of chimeric antigen receptor T-cell (CAR-T) therapies for patients with cancer.

Methods: Electronic databases were searched in October 2022 and updated in September 2023. Systematic reviews, health technology assessments, and economic evaluations that compared costs and effects of CAR-T therapy in patients with cancer were included. Two reviewers independently screened studies, extracted data, synthesized results, and critically appraised studies using the Philips checklist. Cost data were presented in 2022 US dollars.

Results: Our search yielded 1809 records, 47 of which were included. Most of included studies were cost-utility analysis, published between 2018 and 2023, and conducted in the United States. Tisagenlecleucel, axicabtagene ciloleucel, idecabtagene vicleucel, ciltacabtagene autoleucel, lisocabtagene maraleucel, brexucabtagene autoleucel, and relmacabtagene autoleucel were compared with various standard of care chemotherapies. The incremental cost-effectiveness ratio (ICER) for CAR-T therapies ranged from $9424 to $4 124 105 per quality-adjusted life-year (QALY) in adults and from $20 784 to $243 177 per QALY in pediatric patients. Incremental cost-effectiveness ratios were found to improve over longer time horizons or when an earlier cure point was assumed. Most studies failed to meet the Philips checklist due to a lack of head-to-head comparisons and uncertainty surrounding CAR-T costs and curative effects.

Conclusions: CAR-T therapies were more expensive and generated more QALYs than comparators, but their cost-effectiveness was uncertain and dependent on patient population, cancer type, and model assumptions. This highlights the need for more nuanced economic evaluations and continued research to better understand the value of CAR-T therapies in diverse patient populations.

Keywords: cancer; chimeric antigen receptor T-cell therapies; economic evaluation; systematic review.

Publication types

Review