Follicular Lymphoma Therapy Shows Cost-Time Trade-Offs

TOPLINE:

SAN DIEGO — Despite its significantly higher acquisition costs, lisocabtagene maraleucel (liso-cel, Breyanzi) demonstrated better survival and quality of life as well as fewer time toxicity challenges than mosunetuzumab in patients with follicular lymphoma who have received at least two prior lines of therapy, according to a modeling study presented at the American Society of Hematology (ASH) 2024 Annual Meeting.

METHODOLOGY:

• Liso-cel, a CD19-directed chimeric antigen receptor T-cell product, and mosunetuzumab, a CD20/CD3 bispecific antibody, are used to treat patients with relapsed/refractory follicular lymphoma. Assessments of treatment benefits largely focus on economic, clinical, and quality-of-life outcomes; however, patients’ time investment (time toxicity) is often overlooked.
• To assess the costs and time associated with liso-cel and mosunetuzumab, researchers developed a model to calculate total costs, outcomes, and time toxicity for patients receiving these therapies for follicular lymphoma after at least two lines of therapy.
• Researchers designed a health economic model to estimate progression-free survival (PFS). Time toxicity — defined as time spent receiving medical care — included every instance of healthcare resource utilization, such as inpatient or outpatient visits, laboratory tests, and emergency care.
• Pre- and posttreatment costs, long-term monitoring, progression-related costs, adverse event rates, productivity loss, and indirect costs (such as lost wages and travel costs for outpatient visits or hospitalizations) were also analyzed. The model assumed one infusion of liso-cel and eight infusions of mosunetuzumab.
• Time toxicity, clinical, and economic outcomes were evaluated across multiple time horizons (1-5 years, 10 years, and across patients’ lifetime), with 5 years as the base case reported in this study.

TAKEAWAY:

• Over 5 years, patients treated with liso-cel demonstrated a higher median PFS than those treated with mosunetuzumab — 51 months vs 18 months — based on the model. Given its high acquisition cost, in particular, liso-cel costs $265,226 more than mosunetuzumab overall; however, when looking at the cost per PFS month, liso-cel costs less — $11,650 vs $18,180 per month for mosunetuzumab.
• The time toxicity analysis revealed that treatment with mosunetuzumab was a heavier time commitment for patients, requiring 44 days more than treatment with liso-cel, with this gap increasing over time when considering the worse disease progression among patients who received mosunetuzumab.
• Compared with liso-cel, mosunetuzumab resulted in 1148 additional hours of productivity loss, $3126 in lost wages, 246 more miles traveled, and $1323 in additional transportation costs.

IN PRACTICE:

The model demonstrated that while liso-cel has a higher total cost, “it offers clinical and nonclinical benefits compared with mosunetuzumab,” the authors concluded. “The increase in PFS with liso-cel versus mosunetuzumab translates to less downstream [healthcare resource utilization]. Further, as liso-cel only requires a single administration, it provides reduced time toxicity, travel distance, and productivity loss, which improve the quality of life of patients and their caregivers.”

SOURCE:

The study findings, led by Saurabh Dahiya, MD, FACP, Stanford University School of Medicine, Palo Alto, California, were presented at the recent American Society of Hematology 2024 Annual Meeting and published online in Blood.

LIMITATIONS:

The study likely relied on model assumptions that may not fully reflect real-world scenarios.

DISCLOSURES:

No funding information was provided for the study. One author reported receiving research funding from Kite and being a consultant for Adaptive Biotechnologies. Two authors reported being employees of Bristol Myers Squibb and two others being employees of BluePath Solutions. Others reported being consultants and having other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.