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

Autor: Thavorn K; 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., Thompson ER; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada., Kumar S; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada., Heiskanen A; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Agarwal A; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Atkins H; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Transplant and Cell Therapy Program, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada., Shorr R; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada., Hawrysh T; Patient Partner, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada., Chan KK; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada., Presseau J; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Ollendorf DA; 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., Graham ID; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Grimshaw JM; 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., Lalu MM; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada., Nochaiwong S; Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand., Fergusson DA; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Hutton B; Clinical Epidemiology Program, Ottawa Hospital Research Institute, General Campus, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Coyle D; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Kekre N; 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.
Jazyk: angličtina
Zdroj: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2024 Aug; Vol. 27 (8), pp. 1149-1173. Date of Electronic Publication: 2024 Apr 17.
DOI: 10.1016/j.jval.2024.04.004
Abstrakt: 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.
Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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