Cost Effectiveness Analysis of CAR-T Cell Therapy for Patients with Relapsed/Refractory Multiple Myeloma in China

Abstract Background The treatment of relapsed/refractory multiple myeloma (RRMM) dramatically changed with the emergence of chimeric antigen receptor T (CAR-T) cell therapy. The aim of this study was to evaluate the cost-effectiveness of two CAR-T cell treatments for RRMM patients from the perspective of the Chinese healthcare system. Methods Markov modelling was used to evaluate Idecabtagene vicleucel(Ide-cel) and Ciltacabtagene autoleucel (Cilta-cel) compared with currently available salvage chemotherapy for patients with RRMM over a lifetime horizon. The model was developed based on data from the three studies: CARTITUDE-1, KarMMa and MAMMOTH. Each CAR-T cell treatments was compared with currently available salvage chemotherapy. The healthcare cost and utility of RRMM patients were collected in a Chinese single institution. Main outcomes were life-years, discounted lifetime costs, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Results In the base case analysis, 3.5% and 30.4% of RRMM patients were expected to be long-term survivor after 5 years of Ide-cel and Cilta-cel treatment. Compared to salvage chemotherapy, Ide-cel and Cilta-cel were associated with the incremental QALYs of 1.14 and 3.32, and increment cost of US $166,643 and $111,225, leading to ICERs of $146,764 and $33,547 per QALY. In the scenario analyses, the ICER was $138,249 and $28,844 per QALY under assumption that the model starting age is changed from 60 to 55 for Ide-cel and Cilta-cel, and ICER was $148,486 and $40,691 per QALY under assumption that success rate of CAR-T therapy manufacturing was 100%. Conclusions Under the wiling-to-pay of 3 times China's per capita GDP in 2021, Cilta-cel was cost-effectiveness options compared to salvage chemotherapy for patients with RRMM while Ide-cel not. With younger target people, potential price discount and long-term survival improvement, the ICERs of the two CAR-T cell treatments would decrease.