ABCL-101 Cost-Effectiveness of Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma

Abstract

Polatuzumab vedotin in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) significantly increased progression-free survival (PFS) (HR, 0.73; 95% CI: 0.57-0.95) vs rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in the POLARIX clinical trial (NCT03274492). The objective of this analysis was to evaluate the cost-effectiveness of Pola-R-CHP vs R-CHOP in frontline diffuse large B-Cell lymphoma (DLBCL). In our cost-effectiveness model, we derived PFS, overall survival (OS), drug utilization, adverse events (AE), and subsequent treatment from POLARIX, including higher utilization of chimeric antigen receptor-modified T-cell therapy (CAR-T) and stem-cell transplantation in the R-CHOP arm compared with Pola-R-CHP arm. Costs included drug acquisition, AE management, routine medical care, subsequent treatments, end-of-life care, and work productivity. A scenario analysis was conducted to assess the future impact of increased second-line CAR-T utilization. We estimated the life years, quality-adjusted life years (QALY), cost impacts, and incremental cost-effectiveness ratio (ICER) of Pola-R-CHP vs R-CHOP. Probabilistic sensitivity analyses (PSA) were performed to assess the impact of uncertainty on cost per QALY-gained outcomes. The ICER of Pola-R-CHP vs R-CHOP was $80,920/QALY gained from a societal perspective and $96,014/QALY gained from a payer perspective. From a societal perspective, the total cost of Pola-R-CHP was $41,159 higher than R-CHOP, primarily due to higher drug costs ($125,623 vs $34,034, respectively). Drug cost offsets for Pola-R-CHP included subsequent treatment costs (-$42,269), routine care (-$1,195), end-of-life care (-$393), and work productivity (-$7,677). AE management costs were $1,069 higher with Pola-R-CHP vs. R-CHOP. Pola-R-CHP resulted in an increase of 0.50 life years and 0.51 QALYs vs R-CHOP. PSA results demonstrated that Pola-R-CHP was cost-effective in 63.0% of simulations at a willingness-to-pay of $150,000/QALY gained from a societal perspective, and 60.8% of simulations from a payer perspective. In the increased CAR-T use scenario, the ICER was $61,220/QALY gained. Pola-R-CHP was projected to be cost-effective vs R-CHOP in previously untreated DLBCL. Our economic model demonstrates an improvement in QALYs with Pola-R-CHP vs R-CHOP and savings in costs relating to DLBCL progression. These cost-effectiveness results reinforce the clinical findings from POLARIX suggesting that Pola-R-CHP should be considered as a frontline standard of care.