Table 2.

Model costs and utilities

CostBase-case estimate, $Range, $Study or data source
CAR T-cell therapy, total upfront∗  443 118 373 000-711 884 (Component sources detailed below) 
Axi-cel (includes leukapharesis and dose preparation) 395 380 316 304-474 465 HCPCS Q204138  
Rituximab, 10 mg (bridging; SOC therapy) 87.78 70.20-105.30 HCPCS J931235  
Bendamustine, 1 mg (bridging; SOC therapy) 21.26 17.01-25.51 HCPCS J903635  
Obinutuzumab, 10 mg (SOC therapy) 64.42 51.54-77.30 HCPCS J930135  
Ifosfamide, 1 g (bridging) 24.54 19.63-29.45 HCPCS J920835  
Mesna, 200 mg (bridging) 1.89 1.51-2.27 HCPCS J920935  
Etoposide, 10 mg (bridging) 0.71 0.57-0.85 HCPCS J918135  
Mitoxantrone, 5 mg (bridging) 29.19 23.35-35.03 HCPCS J929335  
Cyclophosphamide, 25 mg (conditioning) 1.14 0.91-1.37 HCPCS J853035  
Fludarabine, 50 mg (conditioning) 94.50 75.60-113.40 HCPCS J918535  
Tocilizumab, 1 mg 5.53 4.42-6.64 HCPCS J326235  
Methylprednisolone, 80 mg 10.41 8.33-12.49 HCPCS J104035  
IVIG, 500 mg 43.18 34.54-51.82 HCPCS J145935  
Infusion of CAR T-cell therapy on d 0 310.75 248.60-372.90 HCPCS 0540T38  
Inpatient hospitalization (/d) 2 761.04 2 208.83-3 313.25 Kaiser Family Foundation37  
Total cost of AE treatment, CAR T-cell therapy 18 335.05 14 668.04-22 002.06 Medicare IPPS39  
Allogeneic HSCT 215 865 172 692-259 038 Lin et al, 201916  
Autologous HSCT 77 922 62 338-93 506 Lin et al, 201916  
Lenalidomide, 20 mg 800.98 640.78-961.18 Medicare Part D plan finder40  
Tazemetostat, 200 mg 68.09 54.47-81.71 Medicare Part D plan finder40  
Copanlisib, 1 mg 80.96 64.77-97.15 HCPCS J905738  
Total cost of AE treatment, allogeneic HSCT 8 595.39 6876.31-10 314.47 Laport et al, 201612  
Total cost of AE treatment, autologous HSCT 18 543.27 14 834.62-22 251.92 Jurinovic et al, 201841  
Monthly AE treatment, obinutuzumab + bendamustine 354.20 283.36-425.04 Sehn et al, 201642  
Monthly AE treatment, lenalidomide + rituximab 468.17 374.54-561.80 Leonard et al, 201913  
Monthly AE treatment, rituximab monotherapy 151.54 121.23-181.85 Leonard et al, 201913  
Monthly AE treatment, EZH2 inhibitor 54.51 43.61-65.41 Medicare IPPS39  
Monthly AE treatment, PI3K inhibitor 505.89 404.71-607.07 Medicare IPPS37,39  
EZH2 full genetic sequence testing 282.88 226.30-339.46 HCPCS 8123643  
Positron emission tomography–computed tomography 1 480.34 1 184.27-1 776.41 HCPCS 7881638  
Diagnostic computed tomography (neck, chest, abdomen, pelvis) 725.22 580.18-870.26 HCPCS 70492, 71270, 7417738  
Chemotherapy IV infusion, first h 148.30 118.64-177.96 HCPCS 9641336  
Chemotherapy IV infusion, additional h 31.40 25.12-37.68 HCPCS 9641536  
Chemotherapy IV infusion, additional sequence 71.88 57.50-86.26 HCPCS 9641736  
Preinfusion medication 13.29 10.63-15.95 Barnes et al, 201831  
Routine office visit 147.95 118.36-177.54 HCPCS 9921536  
Complete blood count with differential 7.77 137.46-199.03 HCPCS 8502543  
Comprehensive metabolic panel 10.56 8.45-12.67 HCPCS 8005343  
Lactate dehydrogenase 6.04 4.83-7.25 HCPCS 8361543  
Uric acid 4.52 3.62-5.42 HCPCS 8455043  
BSC, monthly 258.56 206.85-310.27 Barnes et al, 201831  
Lymphoma end-of-life care 60 525 48 420.00-72 630.00 Campbell et al, 200444; Huntington et al, 201821  
Nonlymphoma end-of-life care 48 341 38 672.80-58 009.20 Hogan et al, 200145; Huntington et al, 201821  
CostBase-case estimate, $Range, $Study or data source
CAR T-cell therapy, total upfront∗  443 118 373 000-711 884 (Component sources detailed below) 
Axi-cel (includes leukapharesis and dose preparation) 395 380 316 304-474 465 HCPCS Q204138  
Rituximab, 10 mg (bridging; SOC therapy) 87.78 70.20-105.30 HCPCS J931235  
Bendamustine, 1 mg (bridging; SOC therapy) 21.26 17.01-25.51 HCPCS J903635  
Obinutuzumab, 10 mg (SOC therapy) 64.42 51.54-77.30 HCPCS J930135  
Ifosfamide, 1 g (bridging) 24.54 19.63-29.45 HCPCS J920835  
Mesna, 200 mg (bridging) 1.89 1.51-2.27 HCPCS J920935  
Etoposide, 10 mg (bridging) 0.71 0.57-0.85 HCPCS J918135  
Mitoxantrone, 5 mg (bridging) 29.19 23.35-35.03 HCPCS J929335  
Cyclophosphamide, 25 mg (conditioning) 1.14 0.91-1.37 HCPCS J853035  
Fludarabine, 50 mg (conditioning) 94.50 75.60-113.40 HCPCS J918535  
Tocilizumab, 1 mg 5.53 4.42-6.64 HCPCS J326235  
Methylprednisolone, 80 mg 10.41 8.33-12.49 HCPCS J104035  
IVIG, 500 mg 43.18 34.54-51.82 HCPCS J145935  
Infusion of CAR T-cell therapy on d 0 310.75 248.60-372.90 HCPCS 0540T38  
Inpatient hospitalization (/d) 2 761.04 2 208.83-3 313.25 Kaiser Family Foundation37  
Total cost of AE treatment, CAR T-cell therapy 18 335.05 14 668.04-22 002.06 Medicare IPPS39  
Allogeneic HSCT 215 865 172 692-259 038 Lin et al, 201916  
Autologous HSCT 77 922 62 338-93 506 Lin et al, 201916  
Lenalidomide, 20 mg 800.98 640.78-961.18 Medicare Part D plan finder40  
Tazemetostat, 200 mg 68.09 54.47-81.71 Medicare Part D plan finder40  
Copanlisib, 1 mg 80.96 64.77-97.15 HCPCS J905738  
Total cost of AE treatment, allogeneic HSCT 8 595.39 6876.31-10 314.47 Laport et al, 201612  
Total cost of AE treatment, autologous HSCT 18 543.27 14 834.62-22 251.92 Jurinovic et al, 201841  
Monthly AE treatment, obinutuzumab + bendamustine 354.20 283.36-425.04 Sehn et al, 201642  
Monthly AE treatment, lenalidomide + rituximab 468.17 374.54-561.80 Leonard et al, 201913  
Monthly AE treatment, rituximab monotherapy 151.54 121.23-181.85 Leonard et al, 201913  
Monthly AE treatment, EZH2 inhibitor 54.51 43.61-65.41 Medicare IPPS39  
Monthly AE treatment, PI3K inhibitor 505.89 404.71-607.07 Medicare IPPS37,39  
EZH2 full genetic sequence testing 282.88 226.30-339.46 HCPCS 8123643  
Positron emission tomography–computed tomography 1 480.34 1 184.27-1 776.41 HCPCS 7881638  
Diagnostic computed tomography (neck, chest, abdomen, pelvis) 725.22 580.18-870.26 HCPCS 70492, 71270, 7417738  
Chemotherapy IV infusion, first h 148.30 118.64-177.96 HCPCS 9641336  
Chemotherapy IV infusion, additional h 31.40 25.12-37.68 HCPCS 9641536  
Chemotherapy IV infusion, additional sequence 71.88 57.50-86.26 HCPCS 9641736  
Preinfusion medication 13.29 10.63-15.95 Barnes et al, 201831  
Routine office visit 147.95 118.36-177.54 HCPCS 9921536  
Complete blood count with differential 7.77 137.46-199.03 HCPCS 8502543  
Comprehensive metabolic panel 10.56 8.45-12.67 HCPCS 8005343  
Lactate dehydrogenase 6.04 4.83-7.25 HCPCS 8361543  
Uric acid 4.52 3.62-5.42 HCPCS 8455043  
BSC, monthly 258.56 206.85-310.27 Barnes et al, 201831  
Lymphoma end-of-life care 60 525 48 420.00-72 630.00 Campbell et al, 200444; Huntington et al, 201821  
Nonlymphoma end-of-life care 48 341 38 672.80-58 009.20 Hogan et al, 200145; Huntington et al, 201821  
UtilityBase-case estimate (QALY)RangeStudy or data source
Axi-cel, mo 1 and 2 0.646 0.517-0.775 NICE46; Lin et al, 201916; expert opinion 
HSCT (autologous and allogeneic), mo 1 and 2 0.646 0.517-0.775 NICE46; Lin et al, 201916; expert opinion 
Third-line, without progression 0.846 0.677-1.00 NICE46; expert opinion 
Fourth- and fifth-line targeted therapy 0.785 0.628-0.942 NICE46; expert opinion 
Progression, not on therapy 0.450 0.360-0.540 Lin et al, 201916  
BSC 0.450 0.360-0.540 Lin et al, 201916  
UtilityBase-case estimate (QALY)RangeStudy or data source
Axi-cel, mo 1 and 2 0.646 0.517-0.775 NICE46; Lin et al, 201916; expert opinion 
HSCT (autologous and allogeneic), mo 1 and 2 0.646 0.517-0.775 NICE46; Lin et al, 201916; expert opinion 
Third-line, without progression 0.846 0.677-1.00 NICE46; expert opinion 
Fourth- and fifth-line targeted therapy 0.785 0.628-0.942 NICE46; expert opinion 
Progression, not on therapy 0.450 0.360-0.540 Lin et al, 201916  
BSC 0.450 0.360-0.540 Lin et al, 201916  

IPPS, Inpatient Prospective Payment System; NICE, National Institute for Health and Care Excellence.

∗

Inclusive of cost of axi-cel, leukapheresis, dose preparation, bridging/conditioning therapies, inpatient hospitalization, and AE management.

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