Epcoritamab Plus R2 Demonstrates Long-Term Cost-Effectiveness in Relapsed or Refractory FL

Key Takeaways:

• The addition of epcoritamab to lenalidomide plus rituximab (R2) was associated with more life-years (LYs) and quality‐adjusted LYs (QALYs) than R2 alone in patients with relapsed or refractory follicular lymphoma (R/R FL).
• In both the base-case and sensitivity analyses, epcoritamab plus R2 was found to be more cost-effective than R2 alone, with incremental costs below the established willingness-to-pay (WTP) threshold.
• Epcoritamab plus R2 demonstrated lower incremental costs across longer periods, suggesting that it may provide long-term cost reductions instead of short-term benefits.

The phase 3 EPCORE FL-1 clinical trial demonstrated the clinical efficacy of adding epcoritamab to R2 in treating R/R FL.

The addition of epcoritamab is expected to increase care costs, and few studies have assessed the cost-effectiveness of this therapeutic approach.

Researchers developed a Markov model to evaluate the costs and health outcomes of epcoritamab plus R2 across 30 years. Outcomes included total costs, LYs, QALYs, and incremental cost‐effectiveness ratios (ICER).

Cost-Effectiveness of Epcoritamab Plus R2

In the base-case analysis, epcoritamab plus R2 yielded more LYs compared to R2 alone, 13.16 vs 8.40, respectively. QALYs were significantly higher among patients receiving epcoritamab plus R2 as well, 10.47 compared to 6.53 for R2 alone.

As expected, epcoritamab plus R2 accumulated higher total costs than R2 alone, $739 293.10 vs $471 572.09, respectively. Epcoritamab plus R2 yielded 3.94 QALYs gained at a cost of $267 721.01, resulting in an ICER of $67  974.64 per QALY gained.

In a sensitivity analysis, the ICER ranged from $53 819.80 to $82 129.49 per QALY gained, substantially lower than the WTP threshold of $150 000 per QALY gained. This analysis identified drug acquisition costs as the most significant contributor to ICER.

When analyzed over 10 years instead of 30, the ICER increased to $176 729.50 per QALY, suggesting that the cost-effectiveness of epcoritamab plus R2 comes from long-term health benefits which offset high upfront costs.

Implications for Managed Care

These findings illustrate the cost-effectiveness of epcoritamab plus R2 compared to R2 alone in treatment for R/R FL. Although adding epcoritamab is associated with increased treatment costs, specifically those related to drug acquisition, it may improve disease management and thereby reduce long-term health care spending.

The authors said, “Taken together, these findings indicate that the economic value of epcoritamab plus R2 is jointly determined by high acquisition cost and long-term health gains from prolonged disease control.”

Reference

He Y, Wu M, Yi Y, Wan X. Cost‐effectiveness of epcoritamab plus lenalidomide and rituximab versus lenalidomide and rituximab for relapsed/refractory follicular lymphoma: a US payer perspective. Hematol Oncol. 2026;44(4):e70221. doi:10.1002/hon.70221