Comparative Economic Evaluations of CAR-T Therapies for Relapsed or Refractory Diffuse Large B-Cell Lymphoma: A Systematic Review.

BACKGROUND AND

objectiveChimeric antigen receptor T-cell therapies have changed the treatment paradigm of relapsed or refractory large B-cell lymphoma but are among the most expensive treatments. Moreover, their comparative economic value remains uncertain in adults with relapsed or refractory large B-cell lymphoma. The objective of this study was to understand the comparative value of these therapies in this population and the main factors that influenced conclusions on which intervention was considered more cost effective than others.

methodsTo assess the comparative cost effectiveness of chimeric antigen receptor T-cell therapies and the drivers of cost-effectiveness results, a systematic literature search of Embase, Scopus, and PubMed was conducted from inception to December 2024 and updated in October 2025. Studies were selected if they were full economic evaluations of head-to-head comparisons of chimeric antigen receptor T-cell therapies for relapsed or refractory large B-cell lymphoma. Two reviewers independently extracted data on key information such as population characteristics and model structure. Results were reported in their original format, and conclusions on cost effectiveness were evaluated based on country-specific willingness-to-pay thresholds. The reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist and the Drummond 10-Item Checklist.

resultsEight full economic evaluations across the USA, Spain, France, and Japan were included in this systematic review. All studies modeled an adult population or patients with relapsed or refractory large B-cell lymphoma who had failed two or more lines of prior therapy, were conducted over a lifetime horizon, and mostly used the payer perspective (n = 6). All studies utilized three-state partitioned survival models but relied heavily on indirect comparison methods such as matching-adjusted indirect comparison. Three chimeric antigen receptor T-cell therapies were evaluated: axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel (liso-cel). Axi-cel was the most frequently reported cost-effective option (n = 7) with two studies concluding it was the dominant strategy. There was substantial uncertainty in the model results given the lack of individual patient-level data for each arm and reliance on indirect comparisons.

conclusionsIn this systematic review of economic evaluations of head-to-head comparisons of chimeric antigen receptor T-cell therapies for relapsed or refractory large B-cell lymphoma, current evidence suggests that axi-cel may be the most cost-effective option. However, given the studies' reliance on indirect comparisons and the absence of any study conducted in low- to middle-income countries, these results must be carefully interpreted until additional evaluations or clinical trials are conducted.