Mosunetuzumab Shows Superior Cost-Effectiveness Over CAR-T Therapies in Relapsed/Refractory Follicular Lymphoma
A new cost-effectiveness analysis comparing third-line therapies for relapsed/refractory follicular lymphoma (R/R FL) found that mosunetuzumab (mosun) yields a higher net monetary benefit (NMB) over axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel), supporting its use as a more economically favorable treatment option from a US payer perspective.
Study Overview
Researchers developed a 10-year Markov model to simulate outcomes and costs for mosun, axi-cel, and tisa-cel using clinical trial data, toxicity rates, hospitalization probabilities, and health utilities. Key outcomes included quality-adjusted life years (QALYs), total health care costs, and NMB using a $150 000 willingness-to-pay (WTP) threshold.
Key Findings
Short-Term Results (1 Year)
- QALYs: Mosun (0.68), Axi-cel (0.62), Tisa-cel (0.64)
- Costs: Mosun ($325 654), Axi-cel ($530 369), Tisa-cel ($499 734)
- NMB: Mosun provided $213 642 more value than axi-cel and $179 596 more than tisa-cel
Long-Term Results (10 Years)
- QALYs: Mosun (4.32), Axi-cel (4.23), Tisa-cel (4.13)
- Costs: Mosun ($566 852), Axi-cel ($620 906), Tisa-cel ($650 578)
- NMB: Mosun maintained cost-effectiveness with $67 654 and $111 709 greater NMB than axi-cel and tisa-cel, respectively
Clinical and Economic Considerations
Mosun was associated with lower rates of high-grade cytokine release syndrome and neurotoxicity compared to both CAR-T products, reducing inpatient care costs. CAR-T therapies, while demonstrating higher short-term progression-free survival (PFS), carry high upfront costs and logistical barriers, including hospitalization and caregiver needs.
Probabilistic sensitivity analysis showed that mosun had a 79% probability of being cost-saving and a 68% probability of being cost-effective at the $150 000 WTP threshold.
Conclusion
Mosunetuzumab emerged as the most cost-effective treatment option for 3L+ R/R FL across multiple time horizons, driven by lower costs and favorable toxicity profiles. While CAR-T therapies may offer longer PFS, especially for younger patients, mosun's outpatient availability and lower financial burden make it a compelling frontline option in appropriate patients.
Reference
Lin M H, Weiss J, Phillips T J, et al. Cost effectiveness of mosunetuzumab and CAR-T cell therapy in relapsed/refractory follicular lymphoma. Leukemia & Lymphoma. 2025;66(10):1850–1862. doi: 10.1080/10428194.2025.250649
