scholarly journals Cardiovascular diseases among diffuse large B-cell lymphoma long-term survivors in Asia: a multistate model study

ESMO Open ◽  
2022 ◽  
Vol 7 (1) ◽  
pp. 100363
S.F. Lee ◽  
B.A. Vellayappan ◽  
L.C. Wong ◽  
C.L. Chiang ◽  
S.K. Chan ◽  
2021 ◽  
Vol 27 (3) ◽  
pp. S404-S405
Caron A. Jacobson ◽  
Frederick L. Locke ◽  
Armin Ghobadi ◽  
David B. Miklos ◽  
Lazaros J. Lekakis ◽  

2021 ◽  
Haruka Takahashi ◽  
Takashi Sano ◽  
Sayumi Kawamura ◽  
Keiko Sano ◽  
Ryoma Miyasaka ◽  

Endocrine ◽  
2008 ◽  
Vol 34 (1-3) ◽  
pp. 11-16 ◽  
Sandra Pekic ◽  
Slavica Milicevic ◽  
Natasa Colovic ◽  
Milica Colovic ◽  
Vera Popovic

2019 ◽  
Vol 37 (24) ◽  
pp. 2105-2119 ◽  
John K. Lin ◽  
Lori S. Muffly ◽  
Michael A. Spinner ◽  
James I. Barnes ◽  
Douglas K. Owens ◽  

PURPOSE Two anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapies are approved for diffuse large B-cell lymphoma, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel; each costs $373,000. We evaluated their cost effectiveness. METHODS We used a decision analytic Markov model informed by recent multicenter, single-arm trials to evaluate axi-cel and tisagenlecleucel in multiply relapsed/refractory, adult, diffuse large B-cell lymphoma from a US health payer perspective over a lifetime horizon. Under a range of plausible long-term effectiveness assumptions, each therapy was compared with salvage chemoimmunotherapy regimens and stem-cell transplantation. Main outcomes were undiscounted life years, discounted lifetime costs, discounted quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (3% annual discount rate). Sensitivity analyses explored uncertainty. RESULTS In an optimistic scenario, assuming a 40% 5-year progression-free survival (PFS), axi-cel increased life expectancy by 8.2 years at $129,000/QALY gained (95% uncertainty interval, $90,000 to $219,000). At a 30% 5-year PFS, improvements in life expectancy were more modest (6.4 years) and expensive ($159,000/QALY gained [95% uncertainty interval, $105,000 to $284,000]). In an optimistic scenario, assuming a 35% 5-year PFS, tisagenlecleucel increased life expectancy by 4.6 years at $168,000/QALY gained (95% uncertainty interval, $105,000 to $414,000/QALY). At a 25% 5-year PFS, improvements in life expectancy were smaller (3.4 years) and more expensive ($223,000/QALY gained [95% uncertainty interval, $123,000 to $1,170,000/QALY]). Administering CAR-T to all indicated patients would increase US health care costs by approximately $10 billion over 5 years. Price reductions to $250,000 and $200,000, respectively, or payment only for initial complete response (at current prices) would allow axi-cel and tisagenlecleucel to cost less than $150,000/QALY, even at 25% PFS. CONCLUSION At 2018 prices, it is possible that both CAR-T therapies meet a less than $150,000/QALY threshold. This depends on long-term outcomes compared with chemoimmunotherapy and stem-cell transplantation, which are uncertain. Widespread adoption would substantially increase non-Hodgkin lymphoma health care costs. Price reductions or payment for initial response would improve cost effectiveness, even with modest long-term outcomes.

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