Liso-Cel May Offer Greater Cost-Effectiveness Than Axi-Cel in LBCL

Key Clinical Summary

• A US cost-effectiveness analysis found that lisocabtagene maraleucel (liso-cel) was projected to provide an additional 0.31 quality-adjusted life-years (QALYs) compared with axicabtagene ciloleucel (axi-cel) as second-line treatment for patients with relapsed or refractory large B-cell lymphoma (LBCL).
• Liso-cel was associated with an estimated $9398 reduction in lifetime treatment costs per patient, driven primarily by lower adverse event management, treatment administration, and subsequent therapy costs.
• At a willingness-to-pay threshold of $100 000 per QALY, liso-cel had a 62% probability of being cost-effective compared with axi-cel. However, results were sensitive to assumptions about long-term survival.

Lisocabtagene maraleucel may offer greater economic value than axicabtagene ciloleucel as second-line treatment for transplant-eligible patients with primary refractory or early relapsed LBCL, according to a US cost-effectiveness analysis.

The study, published in Advances in Therapy, projected that liso-cel would provide modest QALY gains while reducing overall treatment costs compared with axi-cel. The findings may help inform managed care decision-making as chimeric antigen receptor (CAR) T-cell therapies become increasingly incorporated into earlier lines of lymphoma treatment.

Economic Model Compares Second-Line CAR T-Cell Therapies

Researchers developed a partitioned survival model to evaluate the cost-effectiveness of liso-cel compared with axi-cel from a US commercial third-party payer perspective.

The analysis focused on transplant-eligible adults with LBCL whose disease was refractory to first-line chemoimmunotherapy or relapsed within 12 months of treatment.

The model incorporated efficacy data from 2 pivotal phase 3 clinical trials: TRANSFORM, which evaluated liso-cel, and ZUMA-7, which evaluated axi-cel.

Because the 2 therapies were not directly compared in a randomized trial, investigators used an indirect treatment comparison, with standard-of-care therapy serving as the common comparator.

The model evaluated 3 health states: event-free survival, post-event survival, and death. Researchers projected costs and outcomes over a 50-year lifetime horizon, applying a 3% annual discount rate.

Costs included CAR T-cell therapy acquisition and administration, pretreatment procedures, adverse event management, hospitalization, subsequent therapies, disease monitoring, and end-of-life care.

Health outcomes were measured in QALYs, incorporating both survival and health-related quality of life.

Liso-Cel Projected to Reduce Lifetime Treatment Costs

In the base-case analysis, liso-cel was projected to provide an additional 0.31 QALYs compared with axi-cel while reducing lifetime costs by $9398 per patient.

Because liso-cel was modeled as both less costly and more effective, it was considered economically dominant over axi-cel in the base-case analysis.

Several cost categories contributed to the projected savings.

Adverse event management costs were $11 109 lower with liso-cel, while CAR T-cell therapy administration costs were $15 074 lower. Subsequent treatment costs were also reduced by $2864.

These savings helped offset the costs associated with liso-cel treatment.

The researchers noted that differences in adverse event management and administration costs are particularly relevant because CAR T-cell therapies require specialized infrastructure, monitoring, and management of potentially serious complications.

The model included adverse events such as cytokine release syndrome, neurologic complications, and hypogammaglobulinemia, which can affect health care utilization and patient quality of life.

Long-Term Survival Assumptions Influence Cost-Effectiveness

The projected economic advantage of liso-cel was influenced substantially by assumptions about long-term survival.

Researchers used mixture cure modeling to extrapolate event-free survival and overall survival beyond the follow-up periods available from TRANSFORM and ZUMA-7.

The model accounted for the possibility that some patients receiving CAR T-cell therapy may achieve durable remission and experience long-term survival approaching that of the general population.

The estimated probability of long-term survival without excess lymphoma-related mortality was the primary driver of cost-effectiveness results.

In probabilistic sensitivity analyses involving 3000 simulations, liso-cel was more effective than axi-cel in 58% of simulations and less costly in approximately 70%.

Liso-cel was both less costly and more effective in 42% of simulations.

At a willingness-to-pay threshold of $100 000 per QALY, the probability that liso-cel was cost-effective compared with axi-cel was 62%.

These findings indicate that although the base-case analysis favored liso-cel, uncertainty remained regarding the magnitude and consistency of its comparative clinical benefit.

Subsequent Treatment Costs May Affect Economic Value

Researchers also examined how alternative assumptions about subsequent treatment and disease monitoring influenced model results.

One scenario assumed that all patients requiring third-line treatment received polatuzumab vedotin plus bendamustine and rituximab.

Under this assumption, the projected incremental cost savings with liso-cel increased by approximately 40%, reflecting the model's prediction that patients receiving liso-cel would progress to subsequent therapy more slowly than those receiving axi-cel.

Other scenario analyses examined changes in long-term survival assumptions, health state utility values, and monitoring requirements.

When investigators assumed that patients remaining event-free required less frequent monitoring after 5 years rather than 2 years, the incremental cost difference increased by approximately 12%, reducing the projected savings associated with liso-cel.

These analyses demonstrate that treatment sequencing, subsequent therapy utilization, and long-term monitoring requirements can influence the estimated economic value of CAR T-cell therapies.

Implications for Managed Care

The findings provide additional economic evidence for managed care organizations evaluating second-line CAR T-cell treatment options for patients with relapsed or refractory LBCL.

Although CAR T-cell therapies involve substantial upfront expenditures, their overall economic value depends on multiple factors beyond acquisition costs, including administration setting, toxicity management, durability of response, and subsequent treatment requirements.

The projected reductions in adverse event management and administration costs with liso-cel suggest that differences in treatment-related resource utilization may influence payer expenditures.

The findings also highlight the importance of incorporating long-term outcomes into economic evaluations. Therapies that produce durable remission may reduce the need for subsequent treatment and ongoing disease management, potentially offsetting some initial costs. However, several limitations should be considered.

The analysis relied on indirect comparisons between separate clinical trials rather than head-to-head evidence. Differences in trial populations, treatment protocols, and follow-up periods may influence comparative effectiveness estimates.

Additionally, lifetime outcomes were extrapolated beyond available clinical trial data, introducing uncertainty into projected survival benefits and cost savings.

The analysis was conducted from a US commercial payer perspective, and results may not directly apply to Medicare, Medicaid, or health systems with different reimbursement structures.

Further real-world studies comparing treatment costs, resource utilization, and long-term outcomes are needed to validate these projections.

Conclusion

This US economic analysis suggests that liso-cel may provide modest additional QALYs at lower lifetime costs than axi-cel as second-line treatment for transplant-eligible patients with primary refractory or early relapsed LBCL.

The projected cost savings were driven primarily by lower adverse event management, treatment administration, and subsequent therapy costs.

Although the base-case analysis favored liso-cel, uncertainty surrounding long-term survival and indirect treatment comparisons underscores the need for additional real-world evidence to inform treatment selection and payer decision-making.

Reference

Deger KA, Liu FF, Klijn SL, et al. Cost-effectiveness of lisocabtagene maraleucel versus axicabtagene ciloleucel as second-line treatment for large B-cell lymphoma in the United States. Adv Ther. 2026. doi: 10.1007/s12325-026-03827-6