{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T22:32:47Z","timestamp":1779143567004,"version":"3.51.4"},"reference-count":49,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Kite, A Gilead Company"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["MDM Policy &amp; Practice"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    <jats:bold>Background.<\/jats:bold>\n                    Chimeric antigen receptor (CAR) T-cell therapies are approved as second-line (2L) or later therapy for diffuse large B-cell lymphoma (DLBCL). Recently, bispecific T-cell antibodies (BsAbs) have been approved as third-line (3L) treatments. The cost-effectiveness of different treatment sequences is unknown. This study aims to evaluate the cost-effectiveness of axicabtagene ciloleucel (axi-cel) compared with other treatment options for 2L DLBCL, from a US health care perspective at a cost-effectiveness threshold of $150,000\u2009per quality-adjusted life-year (QALY).\n                    <jats:bold>Design.<\/jats:bold>\n                    This economic evaluation used a discrete event simulation decision. Model inputs were derived from 8 clinical trials and the published literature. Simulated patients received 2L axi-cel followed by 3L treatments, which were compared with treatment sequences of 2L intended autologous stem cell transplant (ASCT), polatuzumab vedotin with bendamustine and rituximab (Pola-BR), tafasitamab with lenalidomide (tafa-len), or rituximab with gemcitabine and oxaliplatin (R-GemOx), all of which were followed by 3L treatments (salvage chemotherapy, BsAbs, or axi-cel). In addition, axi-cel was compared directly with glofitamab and epcoritamab in 3L. Costs and QALYs, discounted at 3.0%, were used to derive incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs).\n                    <jats:bold>Results.<\/jats:bold>\n                    In the 2L base case, axi-cel was cost-effective compared with intended ASCT (ICER $145,004\/QALY), which was cost-effective compared with R-GemOx (ICER $9,495\/QALY). Axi-cel maximized NMB at $150,000 and $200,000\/QALY thresholds, whereas intended ASCT maximized NMB at $100,000\/QALY. In 3L-focused comparisons with epcoritamab and glofitamab, axi-cel was dominant and cost-effective (ICER $122,224\/QALY), respectively. Axi-cel maximized NMB at $150,000 and $200,000\/QALY thresholds, whereas glofitamab maximized NMB at $100,000\/QALY.\n                    <jats:bold>Conclusions.<\/jats:bold>\n                    The findings of the study suggest that although other treatments were cost-effective at lower thresholds, axi-cel is a cost-effective treatment option in 2L\/3L settings in the United States.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>This study investigated whether axicabtagene ciloleucel (axi-cel) is cost-effective in second-line (2L) and third-line (3L) treatment sequences in the current relapsed or refractory (R\/R) diffuse large B-cell lymphoma (DLBCL) treatment paradigm.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Using a novel treatment sequencing model, axi-cel was found to be cost-effective in both 2L treatment sequences and in direct comparisons with 3L bispecific T-cell antibodies.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>These findings suggest that axi-cel is a cost-effective treatment for R\/R DLBCL regardless of treatment line positioning.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1177\/23814683251345780","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T04:59:55Z","timestamp":1750827595000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["A Cost-Effectiveness Analysis of Diffuse Large B-Cell Lymphoma Treatment Pathways in the United States"],"prefix":"10.1177","volume":"10","author":[{"given":"Anik R.","family":"Patel","sequence":"first","affiliation":[{"name":"Kite, a Gilead Company, Santa Monica, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0180-8972","authenticated-orcid":false,"given":"Bradley","family":"Kievit","sequence":"additional","affiliation":[{"name":"Maple Health Group, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Kite, a Gilead Company, Santa Monica, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markqayne","family":"Ray","sequence":"additional","affiliation":[{"name":"Kite, a Gilead Company, Santa Monica, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rishika","family":"Sharma","sequence":"additional","affiliation":[{"name":"Maple Health Group, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarahmaria","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Maple Health Group, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rob","family":"Blissett","sequence":"additional","affiliation":[{"name":"Maple Health Group, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick L.","family":"Locke","sequence":"additional","affiliation":[{"name":"H. Lee Moffitt Cancer Center &amp; Research Institute, Tampa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_3_2_2_2","volume-title":"StatPearls","author":"Padala SA","year":"2020","unstructured":"Padala SA, Kallam A. Diffuse large B-cell lymphoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26767"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.21037\/aol.2019.09.01"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2022.08.019"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13010070"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.927153"},{"key":"e_1_3_2_8_2","unstructured":"Kite Pharma Inc. YESCARTA\u00ae (axicabtagene ciloleucel) prescribing information (revised 04\/2024). 2024. Available from: https:\/\/www.fda.gov\/media\/108377\/download. [Accessed 17 April 2024]."},{"key":"e_1_3_2_9_2","unstructured":"Novartis. KYMRIAH\u00ae (tisagenlecleucel) Prescribing information (revised 05\/2022). 2022. Available from: https:\/\/www.fda.gov\/media\/107296\/download?attachment. [Accessed 17 April 2024]."},{"key":"e_1_3_2_10_2","unstructured":"Juno Therapeutics Inc. BREYANZI\u00ae (lisocabtagene maraleucel) prescribing information (revised 03\/2024). 2024. Available from: https:\/\/www.fda.gov\/media\/145711\/download?attachment. [Accessed 17 April 2024]."},{"key":"e_1_3_2_11_2","unstructured":"National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines\u00ae). B-cell lymphomas. Version 1.2024 (January 18 2024). 2024. Available from: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/b-cell.pdf. [Accessed 17 April 2024]."},{"key":"e_1_3_2_12_2","unstructured":"Genentech Inc. COLUMVI (glofitamab-gxbm) prescribing information (revised 06\/2023). 2023. Available from: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2023\/761309s000lbl.pdf. [Accessed 17 April 2024]."},{"key":"e_1_3_2_13_2","unstructured":"Genmab US Inc. EPKINLY\u2122 (epcoritamab-bysp) prescribing information (revised 05\/2023). 2023. Available from: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2023\/761324s000lbl.pdf. [Accessed 17 April 2024]."},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11899-021-00628-2"},{"key":"e_1_3_2_15_2","article-title":"NICE\u2019s pathways pilot: pursuing good decision making in difficult circumstances","volume":"8","author":"Lee D","year":"2024","unstructured":"Lee D, Burns D, Wilson E. NICE\u2019s pathways pilot: pursuing good decision making in difficult circumstances. PharmacoEconomics Open. 2024;8:645\u20139.","journal-title":"PharmacoEconomics Open"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2022.08.010"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2023.2290832"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.45956"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2023011793"},{"key":"e_1_3_2_20_2","unstructured":"Institute for Clinical and Economic Review. ICER\u2019s reference case for economic evaluations: principles and rationale. 2020. Available from: https:\/\/icer.org\/wp-content\/uploads\/2024\/02\/ICER-Reference-Case_2024.pdf. [Accessed 6 January 2025]."},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2116133"},{"key":"e_1_3_2_22_2","unstructured":"Kite Pharma. Data on file. ZUMA-1 individual patient data. Santa Monica (CA): Kite A Gilead Company; 2023."},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-03-769620"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1200\/jco.22.01725"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2206913"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.00172"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2021.1901090"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2020.275958"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30864-7"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2022.2065787"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06290495"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2018.1529674"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.02079"},{"key":"e_1_3_2_34_2","unstructured":"IBM Micromedex. REDBOOK. Available from: https:\/\/www.micromedexsolutions.com\/home\/dispatch\/ssl\/true. [Accessed September 2023]."},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V112.11.2373.2373"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1080\/10428190600573325"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-12-9"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01308-8"},{"key":"e_1_3_2_39_2","volume-title":"flexsurvcure: Flexible Parametric Cure Models. R Package Version 1.3.1","author":"Amdahl J","year":"2022","unstructured":"Amdahl J. flexsurvcure: Flexible Parametric Cure Models. R Package Version 1.3.1. 2022. DOI:10.32614\/CRAN.package.flexsurvcure"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.10.015"},{"key":"e_1_3_2_41_2","unstructured":"United States Department of Labor. CPI for all urban consumers medical care services. Available from: https:\/\/beta.bls.gov\/dataViewer\/view\/timeseries\/CUSR0000SAM2. [Accessed 17 November 2023]."},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2023-174918"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2301665"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2023-181177"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2023.09.702"},{"key":"e_1_3_2_46_2","article-title":"Five-year follow-up of ZUMA-1 supports the curative potential of axicabtagene ciloleucel in refractory large B-cell lymphoma","volume":"141","author":"Neelapu SS","year":"2023","unstructured":"Neelapu SS, Jacobson CA, Ghobadi A, et al. Five-year follow-up of ZUMA-1 supports the curative potential of axicabtagene ciloleucel in refractory large B-cell lymphoma. Blood. 2023;141:2307\u201315.","journal-title":"Blood"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2023.09.351"},{"key":"e_1_3_2_48_2","unstructured":"National Institute for Health and Care Excellence. Glofitamab for treating relapsed or refractory diffuse large B-cell lymphoma after 2 or more systemic treatments. Technology appraisal guidance TA927. 2023. https:\/\/www.nice.org.uk\/guidance\/ta927. [Accessed 18 April 2024]."},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2021-148078"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2023.09.703"}],"container-title":["MDM Policy &amp; Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23814683251345780","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23814683251345780","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23814683251345780","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T01:04:18Z","timestamp":1767661458000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23814683251345780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":49,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1177\/23814683251345780"],"URL":"https:\/\/doi.org\/10.1177\/23814683251345780","relation":{},"ISSN":["2381-4683","2381-4683"],"issn-type":[{"value":"2381-4683","type":"print"},{"value":"2381-4683","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"article-number":"23814683251345780"}}