Cost-Effectiveness of Cilta-cel in Lenalidomide-Refractory Multiple Myeloma: An Analysis of the CARTITUDE-4 Trial.

OBJECTIVE: Building upon the survival advantages demonstrated in the Phase III CARTITUDE-4 trial, this study quantifies the cost-effectiveness of ciltacabtagene autoleucel (cilta-cel) versus standard regimens (PVd or DPd) for lenalidomide-refractory multiple myeloma from a US mixed payer perspective. METHODS: A Markov model with 3 or 4-week cycles was developed to simulate long-term clinical trajectories. The economic viability was determined by calculating incremental cost-effectiveness ratios (ICERs) through integrated costs and quality-adjusted life years (QALYs), benchmarked against a willingness-to-pay (WTP) threshold of $150,000/QALY. Robustness was verified via sensitivity and scenario analyses. RESULTS: Under the 10-year time horizon, patients in the cilta-cel cohort accumulated an expected 3.99 QALYs, compared with 2.96 QALYs in the standard-of-care group. Concurrently, the expected total medical costs for the cilta-cel group were $574,425.45, which were lower than the $645,495.60 incurred by the standard therapy group. Compared with conventional treatment, the cilta-cel regimen demonstrated economic absolute dominance, achieving superior health outcomes alongside reduced overall costs. Scenario and sensitivity analyses confirmed the robustness of the model. The acquisition cost of cilta-cel, the subsequent treatment costs in the standard group and the discount rate were identified as the three most influential factors. CONCLUSIONS: Relative to standard therapy, cilta-cel is projected to exhibit an economic absolute cost-effectiveness advantage in the treatment of lenalidomide-refractory multiple myeloma.