Second-Line Chimeric Antigen Receptor T-Cell Therapy in Diffuse Large B-Cell Lymphoma: A Cost-Effectiveness Analysis
Open accessAbstract
BACKGROUND: First-line treatment of diffuse large B-cell lymphoma (DLBCL) achieves durable remission in approximately 60% of patients. In relapsed or refractory disease, only about 20% achieve durable remission with salvage chemoimmunotherapy and consolidative autologous stem cell transplantation (ASCT). The ZUMA-7 (axicabtagene ciloleucel [axi-cel]) and TRANSFORM (lisocabtagene maraleucel [liso-cel]) trials demonstrated superior event-free survival (and, in ZUMA-7, overall survival) in primary-refractory or early-relapsed (high-risk) DLBCL with chimeric antigen receptor T-cell therapy (CAR-T) compared with salvage chemoimmunotherapy and consolidative ASCT; however, list prices for CAR-T exceed $400 000 per infusion. OBJECTIVE: To determine the cost-effectiveness of second-line CAR-T versus salvage chemoimmunotherapy and consolidative ASCT. DESIGN: State-transition microsimulation model. DATA SOURCES: ZUMA-7, TRANSFORM, other trials, and observational data. TARGET POPULATION: "High-risk" patients with DLBCL. TIME HORIZON: Lifetime. PERSPECTIVE: Health care sector. INTERVENTION: Axi-cel or liso-cel versus ASCT. OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (iNMB) in 2022 U.S. dollars per quality-adjusted life-year (QALY) for a willingness-to-pay (WTP) threshold of $200 000 per QALY. RESULTS OF BASE-CASE ANALYSIS: The increase in median overall survival was 4 months for axi-cel and 1 month for liso-cel. For axi-cel, the ICER was $684 225 per QALY and the iNMB was -$107 642. For liso-cel, the ICER was $1 171 909 per QALY and the iNMB was -$102 477. RESULTS OF SENSITIVITY ANALYSIS: To be cost-effective with a WTP of $200 000, the cost of CAR-T would have to be reduced to $321 123 for axi-cel and $313 730 for liso-cel. Implementation in high-risk patients would increase U.S. health care spending by approximately $6.8 billion over a 5-year period. LIMITATION: Differences in preinfusion bridging therapies precluded cross-trial comparisons. CONCLUSION: Neither second-line axi-cel nor liso-cel was cost-effective at a WTP of $200 000 per QALY. Clinical outcomes improved incrementally, but costs of CAR-T must be lowered substantially to enable cost-effectiveness. PRIMARY FUNDING SOURCE: No research-specific funding.
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The costs of CAR-T-cell therapy are approximately USD 400,000 in the United States and CNY 1,200,000 in China.
“Furthermore, the costs of CAR-T-cell therapy are substantial: approximately USD 400,000 in the United States and CNY 1,200,000 in China.”
From The burdens, coping strategies, and unmet needs of family caregivers of Chinese patients with lymphoma receiving commercial CAR-T-cell therapy: A qualitative study (2026) · cites this paper as [12]
The Abstract says CAR-T list prices exceed USD 400,000 per infusion, supporting the approximate U.S. figure. It does not give a price in China or mention CNY 1,200,000; a search for those terms found no supporting passage in our copy. (LLM, conf=0.88)
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Cites
Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma
Neelapu, S. S., Locke, F. L., Bartlett, N. L., Lekakis, L. J., Miklos, D. B., Jacobson, C. A., Braunschweig, I., Oluwole, O. O., Siddiqi, T., Lin, Y., et al. (2017) · New England Journal of Medicine · doi:10.1056/nejmoa1707447 · Cited by 6,030 · see citing works
Self-citationTisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-Cell Lymphoma
Schuster, S. J., Bishop, M. R., Tam, C. S., Waller, E. K., Borchmann, P., McGuirk, J. P., Jäger, U., Jaglowski, S., Andreadis, C., Westin, J. R., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1804980 · Cited by 4,112 · see citing works
Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., Kuntz, K. M., Meltzer, D. O., Owens, D. K., Prosser, L. A., et al. (2016) · JAMA · doi:10.1001/jama.2016.12195 · Cited by 3,069 · see citing works
Guyot, P., Ades, A. E., Ouwens, M., & Welton, N. J. (2012) · BMC Medical Research Methodology · doi:10.1186/1471-2288-12-9 · Cited by 2,560 · see citing works
Abramson, J. S., Palomba, M. L., Gordon, L. I., Lunning, M. A., Wang, M., Arnason, J., Mehta, A., Purev, E., Maloney, D. G., Andreadis, C., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31366-0 · Cited by 2,430 · cited 3× · see citing works
“Chimeric antigen receptor T-cell therapy (CAR-T) directed against cell surface marker CD19 is an effective treatment of relapsed or refractory DLBCL, offering long-term remission in about 40% of patients receiving infusion (2 – 6).”
BackgroundMethodLocke, F. L., Ghobadi, A., Jacobson, C. A., Miklos, D. B., Lekakis, L. J., Oluwole, O. O., Lin, Y., Braunschweig, I., Hill, B. T., Timmerman, J. M., et al. (2019) · The Lancet Oncology · doi:10.1016/s1470-2045(18)30864-7 · Cited by 2,286 · see citing works
Self-citationUpdating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold
Neumann, P. J., Cohen, J. T., & Weinstein, M. C. (2014) · New England Journal of Medicine · doi:10.1056/nejmp1405158 · Cited by 2,249 · see citing works
Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma
Locke, F. L., Miklos, D. B., Jacobson, C. A., Perales, M.-A., Kersten, M.-J., Oluwole, O. O., Ghobadi, A., Rapoport, A. P., McGuirk, J., Pagel, J. M., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2116133 · Cited by 1,607 · see citing works
Self-citationCAR T cells produced in vivo to treat cardiac injury
Rurik, J. G., Tombácz, I., Yadegari, A., Méndez Fernández, P. O., Shewale, S. V., Li, L., Kimura, T., Soliman, O. Y., Papp, T. E., Tam, Y. K., et al. (2022) · Science · doi:10.1126/science.abm0594 · Cited by 1,400 · see citing works
US Valuation of the EQ-5D Health States
Shaw, J. W., Johnson, J. A., & Coons, S. J. (2005) · Medical Care · doi:10.1097/00005650-200503000-00003 · Cited by 1,271 · see citing works
Sehn, L. H., & Salles, G. (2021) · New England Journal of Medicine · doi:10.1056/nejmra2027612 · Cited by 1,225 · see citing works
Time-dependent covariates in the Cox proportional-hazards regression model.
Fisher, L., & Lin, D.-Y. (1999) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.20.1.145 · Cited by 1,055 · see citing works
CAR T Cells Produced in vivo to Treat Cardiac Injury
Rurik, J. G., Tombácz, I., Yadegari, A., Fernández, P. O. M., Shewale, S. V., Li, L., Kimura, T., Soliman, O. Y., Papp, T. E., Tam, Y. K., et al. (2023) · HAL · Cited by 926 · see citing works
Husereau, D., Drummond, M., Augustovski, F., de Bekker-Grob, E., Briggs, A. H., Carswell, C., Caulley, L., Chaiyakunapruk, N., Greenberg, D., Loder, E., et al. (2022) · Value in Health · doi:10.1016/j.jval.2021.10.008 · Cited by 847 · cited 7× · see citing works
“Toour knowledge, this is the fi rst published model evaluating the cost-effectiveness of liso-cel based on the TRANSFORM trial, although other models have evaluated the cost-effectiveness of axi-cel based on the ZUMA-7 trial ( Supplement Table 8 , available at Annals.org) (36, 61, 64, 65).”
MethodInfluentialKamdar, M. K., Solomon, S. R., Arnason, J. E., Johnston, P. B., Glaß, B., Bachanová, V., Ibrahimi, S., Mielke, S., Mutsaers, P. G. N. J., Hernandez‐Ilizaliturri, F. J., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00662-6 · Cited by 809 · see citing works
Polatuzumab Vedotin in Relapsed or Refractory Diffuse Large B-Cell Lymphoma
Sehn, L. H., Herrera, A. F., Flowers, C. R., Kamdar, M. K., McMillan, A., Hertzberg, M., Assouline, S. E., Kim, T. M., Kim, W. S., Özcan, M., et al. (2019) · Journal of Clinical Oncology · doi:10.1200/jco.19.00172 · Cited by 777 · see citing works
One Thousand Health-Related Quality-of-Life Estimates
Tengs, T. O., & Wallace, A. E. (2000) · Medical Care · doi:10.1097/00005650-200006000-00004 · Cited by 658 · see citing works
Schuster, S. J., Tam, C. S. L., Borchmann, P., Worel, N., McGuirk, J. P., Holte, H., Waller, E. K., Jaglowski, S. M., Bishop, M. R., Damon, L. E., et al. (2021) · The Lancet Oncology · doi:10.1016/s1470-2045(21)00375-2 · Cited by 588 · see citing works
Second-Line Tisagenlecleucel or Standard Care in Aggressive B-Cell Lymphoma
Bishop, M. R., Dickinson, M. J., Purtill, D., Barba, P., Santoro, A., Hamad, N., Kato, K., Sureda, A. M., Greil, R., Thiéblemont, C., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2116596 · Cited by 542 · see citing works
Salles, G., Duell, J., González-Barca, E. M., Tournilhac, O., Jurczak, W. J., Liberati, A. M., Nagy, Z., Obr, A., Gaïdano, G., André, M. P. E., et al. (2020) · The Lancet Oncology · doi:10.1016/s1470-2045(20)30225-4 · Cited by 535 · see citing works
Neoantigen T-Cell Receptor Gene Therapy in Pancreatic Cancer
Leidner, R. S., Silva, N. S., Huang, H., Sprott, D. E., Zheng, C., Shih, Y.-P., Leung, A., Payne, R., Sutcliffe, K., Cramer, J., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2119662 · Cited by 527 · see citing works
Side-effect management of chimeric antigen receptor (CAR) T-cell therapy
Schubert, M., Schmitt, M. W., Wang, L., Ramos, C. A., Jordan, K., Müller‐Tidow, C., & Dreger, P. (2020) · Annals of Oncology · doi:10.1016/j.annonc.2020.10.478 · Cited by 493 · see citing works
Eddy, D. M., Hollingworth, W., Caro, J. J., Tsevat, J., McDonald, K. M., & Wong, J. B. (2012) · Value in Health · doi:10.1016/j.jval.2012.04.012 · Cited by 466 · see citing works
Caimi, P. F., Ai, W. Z., Alderuccio, J. P., Ardeshna, K. M., Hamadani, M., Hess, B. T., Kahl, B. S., Radford, J. A., Solh, M., Stathis, A., et al. (2021) · The Lancet Oncology · doi:10.1016/s1470-2045(21)00139-x · Cited by 443 · see citing works
Self-citationHealth state utilities for metastatic breast cancer
Lloyd, A. J., Nafees, B., Narewska, J., Dewilde, S., & Watkins, J. (2006) · British Journal of Cancer · doi:10.1038/sj.bjc.6603326 · Cited by 357 · see citing works
Long-Term Follow-Up of Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy
Cappell, K. M., Sherry, R. M., Yang, J. C.-H., Goff, S. L., Vanasse, D., McIntyre, L. S., Rosenberg, S. A., & Kochenderfer, J. N. (2020) · Journal of Clinical Oncology · doi:10.1200/jco.20.01467 · Cited by 311 · see citing works
Neelapu, S. S., Dickinson, M. J., Munoz, J. L., Ulrickson, M. L., Thiéblemont, C., Oluwole, O. O., Herrera, A. F., Ujjani, C. S., Lin, Y., Riedell, P. A., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-01731-4 · Cited by 294 · see citing works
Sehgal, A. R., Hoda, D., Riedell, P. A., Ghosh, N., Hamadani, M., Hildebrandt, G. C., Godwin, J. E., Reagan, P. M., Wagner‐Johnston, N. D., Essell, J. H., et al. (2022) · The Lancet Oncology · doi:10.1016/s1470-2045(22)00339-4 · Cited by 245 · see citing works
Self-citationLin, J. K., Muffly, L. S., Spinner, M. A., Barnes, J. I., Owens, D. K., & Goldhaber‐Fiebert, J. D. (2019) · Journal of Clinical Oncology · doi:10.1200/jco.18.02079 · Cited by 242 · see citing works
Imhoff, G. W. V., McMillan, A., Matasar, M. J., Radford, J. A., Ardeshna, K. M., Kuliczkowski, K., Kim, W.-S., Hong, X., Gørløv, J. S., Davies, A. J., et al. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2016.69.0198 · Cited by 235 · see citing works
Tisagenlecleucel — the first approved CAR-T-cell therapy: implications for payers and policy makers
Prasad, V. (2018) · Nature Reviews Clinical Oncology · doi:10.1038/nrclinonc.2017.156 · Cited by 229 · see citing works
Arai, S., Jagasia, M., Storer, B. E., Chai, X., Pidala, J., Cutler, C. S., Arora, M., Weisdorf, D. J., Flowers, M. E. D., Martin, P. J., et al. (2011) · Blood · doi:10.1182/blood-2011-03-344390 · Cited by 225 · see citing works
Self-citationCAR T cells as a second-line therapy for large B-cell lymphoma: a paradigm shift?
Westin, J. R., & Sehn, L. H. (2022) · Blood · doi:10.1182/blood.2022015789 · Cited by 169 · see citing works
Kanas, G., Ge, W., Quek, R. G. W., Keeven, K., Nersesyan, K., & Arnason, J. E. (2021) · Leukemia & lymphoma/Leukemia and lymphoma · doi:10.1080/10428194.2021.1975188 · Cited by 150 · see citing works
Vose, J. M., Bierman, P., Anderson, J., Kessinger, A., Pierson, J. L., Nelson, J., Frappier, B., Schmit-Pokorny, K. A., Weisenburger, D. D., & Armitage, J. O. (1992) · Blood · doi:10.1182/blood.v80.8.2142.2142 · Cited by 147 · see citing works
Potential solutions for manufacture of CAR T cells in cancer immunotherapy
Blache, U., Popp, G., Dünkel, A., Koehl, U., & Fricke, S. (2022) · Nature Communications · doi:10.1038/s41467-022-32866-0 · Cited by 142 · see citing works
Chow, V. A., Gopal, A. K., Maloney, D. G., Turtle, C. J., Smith, S. D., Ujjani, C. S., Shadman, M. S., Cassaday, R. D., Till, B. G., Tseng, Y. D., et al. (2019) · American Journal of Hematology · doi:10.1002/ajh.25505 · Cited by 135 · see citing works
Lyman, G. H., Nguyen, A., Snyder, S., Gitlin, M. D., & Chung, K. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.2072 · Cited by 128 · see citing works
Prophylactic tocilizumab prior to anti-CD19 CAR-T cell therapy for non-Hodgkin lymphoma
Caimi, P. F., Pacheco Sanchez, G., Sharma, A., Otegbeye, F., Ahmed, N., Rojas, P., Patel, S., Kleinsorge Block, S., Schiavone, J., Zamborsky, K., et al. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.745320 · Cited by 121 · see citing works
Roth, J. A., Sullivan, S. D., Lin, V. W., Bansal, A., Purdum, A., Navale, L., Cheng, P., & Ramsey, S. D. (2018) · Journal of Medical Economics · doi:10.1080/13696998.2018.1529674 · Cited by 118 · see citing works
Beusterien, K. M., Davies, J. M., Leach, M., Meiklejohn, D. J., Grinspan, J., O'Toole, A., & Bramham-Jones, S. (2010) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-8-50 · Cited by 112 · see citing works
Utility elicitation study in the UK general public for late-stage chronic lymphocytic leukaemia
Tolley, K. H., Goad, C., Yi, Y., Maroudas, P., Haiderali, A., & Thompson, G. J. (2012) · The European Journal of Health Economics · doi:10.1007/s10198-012-0419-2 · Cited by 94 · see citing works
Outcomes of Patients with Large B-cell Lymphoma Progressing after Axicabtagene Ciloleucel
Spiegel, J. Y., Dahiya, S., Jain, M. D., Tamaresis, J. S., Nastoupil, L. J., Jacobs, M. T., Ghobadi, A., Lin, Y., Lunning, M. A., Lekakis, L. J., et al. (2020) · Blood · doi:10.1182/blood.2020006245 · Cited by 93 · see citing works
Greinix, H. T., Eikema, D., Köster, L., Penack, O., Yakoub‐Agha, I., Montoto, S., Chabannon, C., Styczyński, J., Nagler, A., Robin, M., et al. (2021) · Haematologica · doi:10.3324/haematol.2020.265769 · Cited by 91 · see citing works
Allogeneic transplant following CAR T-cell therapy for large B-cell lymphoma
Zurko, J. C., Ramdial, J., Shadman, M. S., Ahmed, S., Szabó, A., Iovino, L., Tomás, A. A., Sauter, C. S., Perales, M., Shah, N. N., et al. (2022) · Haematologica · doi:10.3324/haematol.2022.281242 · Cited by 83 · see citing works
Self-citationWeighting by Inverse Variance or by Sample Size in Meta-Analysis: A Simulation Study
Sánchez‐Meca, J., & Marín‐Martínez, F. (1998) · Educational and Psychological Measurement · doi:10.1177/0013164498058002005 · Cited by 82 · see citing works
Bachier, C. R., Aggarwal, S. K., Hennegan, K., Milgroom, A., Francis, K. M., Dehipawala, S., & Rotta, M. (2020) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2020.12.027 · Cited by 81 · see citing works
Doorduijn, J. K., Buijt, I., van der Holt, B., Steijaert, M., Groot, C. A. U., & Sonneveld, P. (2005) · European Journal Of Haematology · doi:10.1111/j.1600-0609.2005.00438.x · Cited by 67 · see citing works
Expanding Access to Chimeric Antigen Receptor T-Cell Therapies: Challenges and Opportunities
Kansagra, A. J., Farnia, S. H., & Majhail, N. S. (2020) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_279151 · Cited by 62 · see citing works
Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis
Yalniz, F., Murad, M. H., Lee, S. J., Pavletic, S. Z., Khera, N., Shah, N. D., & Hashmi, S. K. (2018) · Transplantation and Cellular Therapy · doi:10.1016/j.bbmt.2018.03.008 · Cited by 56 · see citing works
Terui, Y., Rai, S., Izutsu, K., Yamaguchi, M., Takizawa, J., Kuroda, J., Ishikawa, T., Kato, K., Suehiro, Y., Fukuhara, N., et al. (2021) · Cancer Science · doi:10.1111/cas.14937 · Cited by 51 · see citing works
Frödin, U., Börjeson, S., Lyth, J., & Lotfi, K. (2010) · Bone Marrow Transplantation · doi:10.1038/bmt.2010.304 · Cited by 49 · see citing works
Vokinger, K. N., Hwang, T. J., Carl, D., Laube, Y., Ludwig, W.-D., Naci, H., & Kesselheim, A. S. (2022) · The Lancet Oncology · doi:10.1016/s1470-2045(22)00073-0 · Cited by 47 · see citing works
Mixture Cure Models in Oncology: A Tutorial and Practical Guidance
Felizzi, F., Paracha, N., Pöhlmann, J., & Ray, J. A. (2021) · PharmacoEconomics - Open · doi:10.1007/s41669-021-00260-z · Cited by 46 · see citing works
Choe, J. H., Abdel‐Azim, H., Padula, W. V., & Abou‐El‐Enein, M. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.45956 · Cited by 41 · see citing works
Dahi, P. B., Lee, J., Devlin, S. M., Ruiz, J. D., Maloy, M., Rondon-Clavo, C., Petrlik, E., Tamari, R., Shah, G. L., Scordo, M., et al. (2021) · Blood Advances · doi:10.1182/bloodadvances.2020004167 · Cited by 40 · see citing works
Perales, M., Kuruvilla, J. G., Snider, J. T., Vadgama, S., Blissett, R. S., Moustaid, F. E., Smith, N., Patel, A. R., & Johnston, P. B. (2022) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2022.08.010 · Cited by 37 · see citing works
Simulation and critical care modeling
Kreke, J. E., Schaefer, A. J., & Roberts, M. S. (2004) · Current Opinion in Critical Care · doi:10.1097/01.ccx.0000139361.30327.20 · Cited by 35 · see citing works
Vijenthira, A., Kuruvilla, J. G., Crump, M., Jain, M. D., & Prica, A. A. (2022) · Journal of Clinical Oncology · doi:10.1200/jco.22.00478 · Cited by 35 · see citing works
Kambhampati, S., Saumoy, M., Schneider, Y., Serrao, S., Solaimani, P., Budde, L. E., Mei, M. G., Popplewell, L. L., Siddiqi, T., Zain, J. M., et al. (2022) · Blood · doi:10.1182/blood.2022016747 · Cited by 34 · see citing works
Mitigating inequity: ethically prioritizing patients for CAR T-cell therapy
Bell, J. A. H., Jeffries, G. A., & Chen, C. I. (2023) · Blood · doi:10.1182/blood.2023020703 · Cited by 32 · see citing works
Ghafouri, S. N., Fenerty, K. E., Schiller, G. J., de Vos, S., Eradat, H. A., Timmerman, J. M., Larson, S. M., & Mead, M. D. (2021) · Clinical Lymphoma Myeloma & Leukemia · doi:10.1016/j.clml.2021.07.002 · Cited by 26 · see citing works
Frödin, U., Lotfi, K., Fomichov, V., Juliusson, G., & Börjeson, S. (2015) · European Journal of Cancer Care · doi:10.1111/ecc.12350 · Cited by 19 · see citing works
Vadgama, S., Mann, J., Bashir, Z., Spooner, C., Collins, G. P., & Bullement, A. (2022) · Value in Health · doi:10.1016/j.jval.2021.10.015 · Cited by 18 · see citing works
Yu, J., Lal, L. S., Anderson, A. J., DuCharme, M., Parasuraman, S. V., & Weisdorf, D. J. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05382-4 · Cited by 16 · see citing works
Howell, T. A., Matza, L. S., Jun, M. P., Garcia, J., Powers, A., & Maloney, D. G. (2022) · PharmacoEconomics - Open · doi:10.1007/s41669-021-00316-0 · Cited by 15 · see citing works
Sigmund, A. M., Denlinger, N., Huang, Y., Bond, D. A., Voorhees, T. J., Bajwa, A., Elder, P., Brammer, J. E., Saad, A. A., Penza, S. L., et al. (2022) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2022.02.021 · Cited by 11 · see citing works
Mohyuddin, G. R., Atieh, T., Ahmed, N., Sborov, D. W., McClune, B. L., Abdallah, A.-O. A., Goodman, A. M., Aziz, M., Allen, I. E., & Prasad, V. K. (2021) · European Journal of Cancer · doi:10.1016/j.ejca.2021.07.036 · Cited by 11 · see citing works
PCN351 - HEALTH-STATE UTILITY VALUES IN DIFFUSE LARGE B-CELL LYMPHOMA
Wang, H., Manca, A., Crouch, S., Bagguley, T., Yu, G., Aas, E., Howell, D. A., Burton, C. H., Patmore, R. D., Roman, E., et al. (2018) · Value in Health · doi:10.1016/j.jval.2018.09.433 · Cited by 9 · see citing works
Betts, K. A., Thuresson, P.-O., Felizzi, F., Du, E. X., Dieye, I., Jia, L., Schulz, M., & Masaquel, A. S. (2020) · Journal of Comparative Effectiveness Research · doi:10.2217/cer-2020-0057 · Cited by 8 · see citing works
Cost-effectiveness of Aducanumab and Donanemab for Early Alzheimer Disease—Estimating the True Value
Cliff, E. R. S., & Kelkar, A. H. (2022) · JAMA Neurology · doi:10.1001/jamaneurol.2022.3101 · Cited by 4 · see citing works
Self-citationUnresolved questions in the second-line use of CAR-T cells for diffuse large B cell lymphoma
Cliff, E. R. S., Merryman, R. W., Armand, P. A., & Jacobson, C. A. (2022) · Nature Medicine · doi:10.1038/s41591-022-02067-9 · Cited by 1 · see citing works
Self-citationPSY191 - HEALTH STATE UTILITIES ASSOCIATED WITH TREATMENT FOR TRANSFUSION DEPENDENT B-THALASSEMIA
Matza, L. S., Paramore, C., Stewart, K., Syrad, H., Jobanputra, M., & Dietz, A. C. (2018) · Value in Health · doi:10.1016/j.jval.2018.09.2765 · Cited by 1 · see citing works
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Lu, P., Ruan, D., Huang, M., Tian, M., Zhu, K., Gan, Z., & Xiao, Z. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-01852-x · Cited by 726 · see citing works
Gagelmann, N., Bishop, M. R., Ayuk, F. A., Bethge, W. A., Glaß, B., Sureda, A. M., Pasquini, M. C., & Kröger, N. M. (2024) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2024.01.074 · Cited by 51 · see citing works
CAR-T cells for treating systemic lupus erythematosus: A promising emerging therapy
Guffroy, A., Jacquel, L., Guffroy, B., & Martin, T. (2024) · Joint Bone Spine · doi:10.1016/j.jbspin.2024.105702 · Cited by 31 · see citing works
Hadidi, S. A., Heslop, H. E., Brenner, M. K., & Suzuki, M. (2024) · Molecular Therapy · doi:10.1016/j.ymthe.2024.05.039 · Cited by 28 · see citing works
In vivo engineering of CAR-T cells: delivery strategies and clinical translation
Gao, Y., Hu, J.-L., An, N., Wen, X., & Li, C.-R. (2026) · Biomarker Research · doi:10.1186/s40364-026-00899-y · Cited by 26 · see citing works
“These logistical burdens restrict timely treatment, limit scalability, and challenge the feasibility of global implementation [17].”
Ge, A. Y., Feldman, W. B., Kaiser, M., Rejeski, K., Iacoboni, G., Narula, G., Chan, J. Y., Dickinson, M. J., Kesselheim, A. S., & Cliff, E. R. S. (2026) · Blood · doi:10.1182/blood.2025030872 · Cited by 19 · see citing works
Self-citationApplication of Carbon Nanomaterials to Enhancing Tumor Immunotherapy: Current Advances and Prospects
Li, Y., Xu, Z., Qi, Z., Huang, X., Li, M., Liu, S., Yan, Y., & Gao, M. (2024) · International Journal of Nanomedicine · doi:10.2147/ijn.s480799 · Cited by 19 · see citing works
“16,17 To address these challenges, combination immunotherapy strategies and nanoparticle therapy are gaining attention.”
BackgroundDholaria, B., Bhaskar, S., Patel, V. G., Biltibo, E. A., Jayani, R., Sengsayadeth, S. M., Jallouk, A. P., Jerkins, J. H., Baer, B., Nur, A., et al. (2025) · Bone Marrow Transplantation · doi:10.1038/s41409-025-02551-z · Cited by 11 · see citing works
“However, the inpatient location for the delivery of CAR-T remained the standard which has contributed in no small way to the high cost of CAR-T treatment [12, 13].”
Budayr, O. M., Miller, B. C., & Nguyen, J. (2024) · Journal of Controlled Release · doi:10.1016/j.jconrel.2024.12.011 · Cited by 9 · see citing works
Patel, N., Farid, S., & Gomes, M. (2025) · PharmacoEconomics - Open · doi:10.1007/s41669-025-00614-x · Cited by 6 · see citing works
“%) comparisons indicated CAR T-cell therapy was not cost effective [16, 38–40, 42, 52, 55, 63, 64, 66–68], 21 comparisons made inconclusive recommendations [28–30, 39, 43, 44, 46, 50, 60, 61, 65] and 46 (51”
InfluentialTan, Y. H., Yoon, D. H., Davies, A. J., Buske, C., Boo, Y. L., Somasundaram, N., Lim, F., Ong, S. Y., Jeyasekharan, A. D. D., Izutsu, K., et al. (2025) · Discover Oncology · doi:10.1007/s12672-025-01860-5 · Cited by 6 · see citing works
Stewart, D. A., Kuruvilla, J. G., Lee, D., Dudebout, J. J., Chua, N. S., Larouche, J.-F., Baetz, T. D., Shafey, M., Abdel‐Samad, N., Robinson, S., et al. (2024) · British Journal of Haematology · doi:10.1111/bjh.19555 · Cited by 5 · see citing works
“13,14 17 Finally, preserving a role for ASCT maintains an additional possible curative approach for appropriate patients with relapsed DLBCL.”
Puglianini, O. A. C., & Chávez, J. C. (2024) · Seminars in Hematology · doi:10.1053/j.seminhematol.2024.08.005 · Cited by 5 · see citing works
Yamamoto, C., Honda, S., Tominaga, R., Yokoyama, D., Furuki, S., Noguchi, A., Koyama, S., Murahashi, R., Nakashima, H., Kawaguchi, S., et al. (2025) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2025.02.013 · Cited by 3 · see citing works
Loftus, T. J., Cho, J., Meraz, M., Dhippayom, T., Bock, A. M., Wagner, C. B., Thavorn, K., & Chaiyakunapruk, N. (2025) · Journal of Medical Economics · doi:10.1080/13696998.2025.2600217 · Cited by 3 · see citing works
Goel, U., Mian, A., & Sauter, C. S. (2024) · Clinical Lymphoma Myeloma & Leukemia · doi:10.1016/j.clml.2024.07.020 · Cited by 3 · see citing works
Perales, M., Oluwole, O. O., Patel, A. R., Ray, M. D., Rodríguez‐Guadarrama, Y., Smith, N., Blissett, R. S., Yang, Y., & Locke, F. L. (2025) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2025.09.015 · Cited by 3 · see citing works
Chimeric antigen receptor T-cell therapy for aggressive B-cell lymphomas
Hu, B., Korsos, V., & Palomba, M. L. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1394057 · Cited by 3 · see citing works
Autologous stem cell transplantation meets CAR-T therapy: A synergistic strategy for B-cell lymphoma
Zhao, X., Wu, J., Zhu, X., & Xiao, Y. (2025) · Cell Transplantation · doi:10.1177/09636897251379571 · Cited by 2 · see citing works
“151 Additionally, value-based payment models linking reimbursement to clinical outcomes have been proposed to increase affordability and incentivize treatment efficacy.”
Pérez‐Lamas, L., Sandoval-Sus, J. D., & Chávez, J. C. (2025) · Expert Opinion on Biological Therapy · doi:10.1080/14712598.2025.2451888 · Cited by 2 · see citing works
“To address these issues, appropriate steps will be needed to reduce the economic burden of CAR-T cells [73–75] and several strategies are being explored [76].”
Lin, X., Liu, J., Chen, J., Tang, J., Huang, Z., Wang, Y., & Shi, S. (2026) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2025.100850 · Cited by 1 · see citing works
Lim, N.-A., Sun, Y., Tan, J. Y., Lim, R. M. H., Tan, Y. H., Ng, L. C. K., Lim, F., Goh, Y. T., Hoe, J. T. M., Chiang, J., et al. (2025) · ESMO Real World Data and Digital Oncology · doi:10.1016/j.esmorw.2025.100195 · Cited by 1 · see citing works
Lue, J. K., Bobbili, P. J., Garg, M., Yee, C. W., Ryland, K. E., Gupta, S. L., Liu, D. J. X., Raut, M. K., & Duh, M. S. (2025) · Leukemia Research · doi:10.1016/j.leukres.2025.108117 · Cited by 1 · see citing works
Tran, T. H., & Kim, H. S. J. (2025) · PharmacoEconomics · doi:10.1007/s40273-025-01566-0 · Cited by 1 · see citing works
Nasiri, A. M., Fakih, R. O. E., Chabannon, C., Garderet, L., Kuball, J. H. E., Bazarbachi, A. A., Sureda, A. M., Lima, M. J. G. D., Abid, M. B., Syed, F., et al. (2026) · Bone Marrow Transplantation · doi:10.1038/s41409-026-03044-3 · Cited by 1 · see citing works
Guffroy, A., Jacquel, L., Guffroy, B., & Martin, T. (2025) · Revue du Rhumatisme · doi:10.1016/j.rhum.2025.03.005
Chan, J. Y., Lim, N.-A., Sun, Y., Tan, J. Y., Lim, R. M. H., Tan, Y. H., Ng, L. C. K., Lim, F., Goh, Y. T., Hoe, J. T. M., et al. (2025) · Research Square · doi:10.21203/rs.3.rs-7108890/v1
Wang, C., Huang, Y., Rao, L., Yu, C., Zhang, Y., & Lin, Y. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1498735
Suh, M., Hyung, J., Park, C. S., Go, H., Song, I. H., Chae, E. J., Kim, K. W., Lee, Y. S., Kwon, M., Lee, S.-W., et al. (2025) · British Journal of Haematology · doi:10.1111/bjh.70186
“…that chimeric antigen receptor T-cell (CAR-T) therapy provides a survival benefit over transplantation, 5,6 HD-ASCT remains a crucial therapeutic option for chemosensitive relapses due to its widespread socioeconomic availability 7–9 and particular benefit in late relapses beyond 1 year.”
Predicting CAR-T outcomes in R/R DLBCL: a multicenter real-world study of a 5-index model
Xue, B., Lu, H., Liu, Y., Lu, Y., Zhang, W., Xiu, B., Luo, X., Wang, L., Qian, W., Liang, A., et al. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1863194
“The advent of chimeric antigen receptor T-cell therapy (CAR-T) has transformed the treatment landscape for R/R DLBCL, demonstrating remarkable ef fi cacy in pivotal clinical trials (4).”
Estimating the costs of advanced therapy medicinal products: a systematic review
Mauricio, M., Fernandez, D., Tihaya, M. S., Meij, P., Munsie, M., & van den Hout, W. B. (2026) · Cytotherapy · doi:10.1016/j.jcyt.2026.102988
- Authors
- Kelkar, A. H., Cliff, E. R. S., Jacobson, C. A., Abel, G. A., Dijk, S. W., Krijkamp, E. M., Redd, R., Zurko, J. C., Hamadani, M., Hunink, M. G. M., & Cutler, C.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Erasmus MC (NL)
- Dana-Farber Cancer Institute (US)
- University of Wisconsin–Madison (US)
- Medical College of Wisconsin (US)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2023-12
- Volume
- 176
- Issue
- 12
- Pages
- 1625-1637
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W4389301999
- Cited by
- 31
- References
- 73
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 10
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- green
- pure.eur.nl
- Licence
- other-oa
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Oncology › CAR-T cell therapy research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Keywords
- diffuse large B-cell lymphoma, axicabtagene ciloleucel, lisocabtagene maraleucel, autologous stem cell transplantation, cost-effectiveness, incremental cost-effectiveness ratio, net monetary benefit, quality-adjusted life years
- MeSH terms
- Receptors, Chimeric Antigen, Cost-Effectiveness Analysis, Humans, Transplantation, Autologous, Lymphoma, Large B-Cell, Diffuse, Hematopoietic Stem Cell Transplantation
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