Session: 902. Health Services and Quality Improvement: Lymphoid Malignancies: Poster II
Hematology Disease Topics & Pathways:
Research, Lymphomas, Non-Hodgkin lymphoma, Bispecific Antibody Therapy, Clinical Research, Health outcomes research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies
Methods: A partitioned survival model was simulated, based on 3 health states: progression-free survival (PFS), post-progression survival, and death. Due to the lack of long-term follow-up data, several parametric fit approaches were considered to extrapolate outcomes from each treatment’s pivotal trial (i.e. E7438-G000-101 for tazemetostat [NCT01897571]; ZUMA-5 for axi-cel [NCT03105336]; TRANSCEND FL for liso-cel [NCT04245839]; ELARA for tisa-cel [NCT03568461]; GO29781 for mosunetuzumab [NCT02500407]; and ROSEWOOD for ZO [NCT03332017]). Based on statistical analyses, visual inspection, and clinical expert input, the PFS and overall survival for all treatments were extrapolated using a log-normal model and an exponential model, respectively. The relative treatment efficacy of mosunetuzumab vs alternative treatment options was estimated from a matching-adjusted indirect treatment comparison analysis. Direct costs in 2024 US dollars (including costs of the drug, wastage, administration, and management of Grade ≥3 severe adverse events and cytokine release syndrome) were evaluated. Over a lifetime horizon, both cost and outcomes were discounted at 3% annually. The cost-effectiveness analysis outputs were measured by dividing the incremental cost by the incremental life year (LY; $ per LY); dividing the incremental cost by the incremental quality adjusted life year (QALY; $ per QALY); and subtracting the incremental cost from the product of incremental QALY and willingness to pay (WTP) threshold of $150,000 per QALY (net monetary benefit [NMB]).
Results: Compared with alternative treatment options, over a lifetime horizon, mosunetuzumab was projected to have a mean total cost of care that was −$795,092 vs ZO; −$321,023 vs axi-cel; −$305,014 vs liso-cel; −$288,633 vs tisa-cel; and −$118,509 vs tazemetostat. In addition, mosunetuzumab was projected to have a mean LY and QALY, respectively, of +9.71 and +7.72 vs tazemetostat; +3.17 and +2.18 vs axi-cel; +5.63 and +4.45 vs ZO; and +0.97 and +0.57 vs tisa-cel. In contrast, liso-cel was projected to have a +0.82 LY and +0.93 QALY vs mosunetuzumab. With the lower cost of care and incremental LY/QALY gains, mosunetuzumab was dominant vs tisa-cel (−$297,009 per LY; −$506,352 per QALY), ZO (−$141,268 per LY; −$178,775 per QALY), axi-cel (−$101,351 per LY; −$147,351 per QALY), and tazemetostat (−$12,199 per LY; −$15,361 per QALY). With the higher cost of care and better outcomes, at a WTP of $150,000 per QALY, liso-cel was not cost-effective vs mosunetuzumab at +$372,165 per LY and +$327,699 per QALY. At a WTP of $150,000 per QALY, the NMB of mosunetuzumab vs alternative treatments was greater than zero, demonstrating mosunetuzumab as cost-effective vs ZO ($1,462,206), tazemetostat ($1,275,779), axi-cel ($647,817), tisa-cel ($374,136), and liso-cel ($165,398).
Conclusions: This study found that mosunetuzumab is a cost-effective treatment vs alternative novel treatment options, for adult patients with 3L+ R/R FL. These findings provide additional economic evidence which has the potential to further inform payers, providers, and patients on how best to value the broadening therapeutic armamentarium in indolent R/R FL. Sensitivity analyses are ongoing to evaluate the robustness of base-case findings. Further analyses are also ongoing and will be presented for the cost-effectiveness of mosunetuzumab vs epcoritamab, which was recently approved for 3L+ R/R FL.
Disclosures: Matasar: IMV Therapeutics: Honoraria; Genmab: Membership on an entity's Board of Directors or advisory committees; Kite: Honoraria; Merck: Current equity holder in publicly-traded company; GM Biosciences: Consultancy, Research Funding; Allogene: Membership on an entity's Board of Directors or advisory committees; BMS/Celgene: Honoraria; Takeda: Honoraria; Epizyme: Honoraria; Pfizer: Honoraria; Pharmacyclics: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria, Research Funding; Johnson & Johnson: Consultancy, Honoraria, Research Funding; Immunovaccine Technologies: Research Funding; ADC Therapeutics: Honoraria; Regeneron Pharmaceuticals, Inc.: Honoraria; AstraZeneca: Honoraria; Bayer: Consultancy, Honoraria, Research Funding. Rosettie: Genentech, Inc.: Current Employment; IQVIA, Inc.: Ended employment in the past 24 months; F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company. Mecke: F. Hoffmann-La Roche Ltd: Current Employment; F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company. Di Maio: F. Hoffmann-La Roche Ltd: Current Employment; F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company; F. Hoffmann-La Roche Ltd: Other. Lin: Genentech, Inc./F. Hoffmann-La Roche Ltd: Current Employment; F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company. Wu: F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company; Genentech, Inc.: Current Employment. Ma: F. Hoffmann-La Roche Ltd: Current equity holder in publicly-traded company; Genentech, Inc.: Current Employment.
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