Article title: Practice efficiency and total cost of care with bispecifics and CAR-T in relapsed/refractory diffuse large B-cell lymphoma: an institutional perspective
Authors: Lei, M., Li, Q., O'Day, K., Meyer, K., & Jun, M.
Journal: Future Oncology
DOI: https://dx.doi.org/10.1080/14796694.2024.2354157
In Table 1 an additional footnote has been inserted relating to the heading ‘Epcoritamab’ the added footnote reads ‘Grade 3/4 CRS was rounded to 3.0% and Grade 3+ ICANS was rounded to 1.0% in model calculations’.
Table 1.
Model inputs and sources.
| Parameter | Value | Source | |
|---|---|---|---|
| Medication costs | |||
| Dexamethasone, iv. | $0.12/mg | 21 | |
| Methylprednisolone, iv. | $12.03/80 mg | 21 | |
| Prednisone, PO | $0.05/5 mg | 21 | |
| Acetaminophen, PO | $0.03/500 mg | 22 | |
| Diphenhydramine, PO/IV | $0.02/50 mg PO, $1.07/50 mg IV | 21,22 | |
| Obinutuzumab, iv. | $7,775.32/1000 mg | 23 | |
| Zofran,a PO | $38.74/8 mg | 23 | |
| Fludarabine, iv. | $108.75/50 mg | 23 | |
| Cyclophosphamide, iv. | $338.89/500 mg | 23 | |
| Epcoritamab, SC | $1,268.8/4 mg, $15,225.56/48 mg | 23 | |
| Glofitamab, iv. | $2,554.74/2.5 mg, $10,218.98/10 mg | 23 | |
| Axicabtagene, iv. | $424,000 per infusion bag | 23 | |
| Polatuzumab vedotin, iv. | $16,550.04/140 mg | 23 | |
| Rituximab, iv. | $939.52/100 mg | 23 | |
| AE cost per event | |||
| CRS, grade 1 | $13,584 | 21,24–27 | |
| CRS, grade 2 | $23,763 | ||
| CRS, grade 3/4 | $60,703 | ||
| ICANS, grade 1 c | $0 | ||
| ICANS, grade 2 | $31,151 | ||
| ICANS, grade 3/4 | $22,973 | ||
| Anemia, grade 3/4 | $16,032 | ||
| Neutropenia, grade 3/4 | $22,365 | ||
| Thrombocytopenia, grade 3/4 | $21,428 | ||
| Infection, grade 3/4 | $10,873 | ||
| Febrile neutropenia, grade 3/4 | $22,365 | ||
| Lymphopenia, grade 3/4 | $22,365 | ||
| Personnel hourly wage | |||
| Pharmacy technician | $19.9 | 28 | |
| Pharmacist | $64.1 | ||
| Registered nurse | $44.1 | ||
| Fringe benefit rate | 41.6% | 29 | |
| Blood test reimbursement | |||
| Complete blood cell count | $8.6 | 30 | |
| Comprehensive metabolic panel | $11.7 | ||
| Coagulation profiling | $6.7 | ||
| Reimbursement/cost ratio | 0.87 | 31 | |
| % staff effort during infusion | 64% | 32 | |
| % staff effort during inpatient monitoring | 25% | Assumption based on clinical KOL opinion | |
| Input—AE rates by treatment8,9,20 | |||
|---|---|---|---|
| AEs | Epcoritamab d | Glofitamab | Axi-cel |
| CRS | |||
| Grade 1 | 37.0% | 52.0% | 40.5% |
| Grade 2 | 17.0% | 14.0% | 40.5% |
| Grade 3/4 | 2.5% | 4.1% | 13.0% |
| ICANS | |||
| Grade 1 | 4.5% | 2.4% | 28.0% |
| Grade 2 | 1.3% | 0.8% | 28.0% |
| Grade 3+ | 0.6% | 1.6% | 31.0% |
| Other grade 3/4 events | |||
| Anemia | 12.0% | 8.0% | 60.0% |
| Neutropenia | 32.0% | 26.0% | 92.0% |
| Thrombocytopenia | 12.0% | 8.0% | 56.0% |
| Infection | 15.0% | 10.0% | 17.0% |
| Febrile neutropenia | 3.0% | 3.4% | 31.0% |
| Lymphopenia | 77.0% | 83.0% | 96.0% |
| Input: Staff and chair time per dose of treatment (in minutes) b ,33–39 | |||
|---|---|---|---|
| Epcoritamab | Glofitamab | Axi-cel | |
| Pre-treatment | |||
| Staff | – | 304e | – |
| Chair | – | 390e | – |
| Blood work | |||
| Staff | 11 | 11 | 22 |
| Chair | 0 | 0 | 0 |
| Premedication (or collection/bridging/conditioning for axi-cel) | |||
| Staff | 52 | 60 | 871 |
| Chair | 98 | 107 | 1,129 |
| Treatment administration | |||
| Staff | 44 | 164 | 64 |
| Chair | 33 | 210 | 64 |
Branded form of ondansetron. If using generic ondansetron, total cost for axi-cel will be lowered by $194 over the 1-year time horizon.
Assumptions based on clinical KOL opinion.
Cost for ICANS was based on resource use in Abramson et al. 2021 and the unit costs of resources. The utilization of resources for an ICANS grade 1 event was reported as $0.
Grade 3/4 CRS was rounded to 3.0% and Grade 3+ ICANS was rounded to 1.0% in model calculations.
Pre-treatment staff and chair time for glofitamab were due to the requirement for pre-treatment with obinutuzumab.
AE: Adverse event; Axi-cel: Axicabtagene ciloleucel; CRS: Cytokine release syndrome; ICANS: Immune effector cell-associated-neurotoxicity syndrome; iv.: Intravenous; KOL: Key opinion leader; PO: By mouth; SC: Subcutaneous.
The Grade 3/4 value for Epcoritamab within the ‘CRS’ section of the table has been updated to ‘2.5%’ from ‘3%’ to accurately reflect the rate in the product prescribing information.
Furthermore the ‘Grade 3/4’ subcategory within the ‘ICANS’ section has been changed to ‘Grade 3+’ based on the fact that the only non-Grade 1/2 ICANS event was Grade 5 according to the product prescribing information.
The ‘Epcoritamab’ value for this subcategory (Grade 3+, see previous point) has been changed to ‘0.6%’ from ‘1%’ to accurately reflect the rate in the product prescribing information.
The figure captions for Figures 2 and 3 were mistakenly switched, the caption for Figure 2 related to Figure 3 and vice versa. This has now been rectified.
Parts a and c were mistakenly swapped within figure 3. This has now been corrected.
The incorrect figure was published for figure 4, this has now been corrected.
Corrections
Figure 2. Total cost breakdown over each time horizon.
a Note: When examining costs over median duration of treatment, total costs were lower for glofitamab, while monthly costs were lower for epcoritamab.
Figure 3. Per-patient personnel and chair time of comparators vs epcoritamab. (A) 1-year time horizon. (B) 6-month time horizon. (C) Median cycles time horizon.
Figure 4. Total costs for epcoritamab and glofitamab by 4-week interval over 1-year time horizon.
Note: The spikes with the glofitamab line are due to the cluster of two doses during weeks 9 to 12 and 21 to 24 when the 3-week cycle is mapped over to a 4-week interval.