Budget impact of introducing glofitamab for treatment of relapsed or refractory diffuse large B-cell lymphoma after two or more lines of systemic therapy in the United States

BACKGROUND: Glofitamab is a T-cell engaging bispecific monoclonal antibody that was granted accelerated approval from the United States Food and Drug Administration for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified or large B-cell lymphoma arising from follicular lymphoma, after ≥2 lines of systemic therapy (3L+). METHODS: A budget impact model was developed for a hypothetical blended commercial/Medicare health plan with 1, 000, 000 members. Comparators were axicabtagene ciloleucel (Axi-cel), lisocabtagene maraleucel (Liso-cel), tisagenlecleucel (Tisa-cel), loncastuximab tesirine, polatuzumab vedotin + bendamustine + rituximab, rituximab + gemcitabine + oxaliplatin, tafasitamab + lenalidomide, and epcoritamab (Epcor). Total costs included those for drugs, wastage, administration, grade ≥3 adverse reactions, and all-grade cytokine release syndrome) and routine care. Market shares were based on internal projections and expert opinions. Total and per-member per-month (PMPM) net budget impacts over 3 years were calculated. RESULTS: Approximately nine patients were projected to be eligible for 3L + DLBCL treatment in a health plan of 1, 000, 000 members. The introduction of glofitamab as a treatment option resulted in estimated total and PMPM cost savings of 728, 697 and -0. 0202, respectively, over 3 years. Costs were reduced across all cost categories but particularly in drug costs. Among the newer therapies, total 3-year cost per treated patient was lowest for glofitamab: 226, 658 versus Tisa-cel = 564, 113; Axi-cel = 540, 002; Liso-cel = 516, 272; and Epcor = 335, 293. Across all sensitivity analyses, the inclusion of glofitamab had minimal PMPM budget impact, ranging from -0. 0256 to -0. 0108. CONCLUSIONS: With the lowest 3-year total cost per treated patient among the newer therapies, glofitamab being an available option in the 3L + DLBCL market is estimated to save a hypothetical 1, 000, 000-member health plan 728, 697 in cumulative total costs and 0. 0202 in PMPM costs over 3 years.