The different forms of B-cell lymphoma are the most common malignant types of lymph node cancer among adults. B-cell leukaemia is the most common malignant form of blood cancer among children and young adults. The compulsory health insurance will assume third-line therapy costs for different types of B-cell lymphoma among adults and B-cell leukaemia among children and young adults with the CAR-T cell therapies Yescarta® and Kymriah® on a provisional basis until the end of 2024. This report examines the effectiveness and safety of these CAR-T cell therapies as well as the cost-benefit ratio, the budgetary impact and ethical, legal, social and organisational issues.
A systematic review of clinical studies showed that treatment of B-cell lymphomas with Yescarta® has a higher survival rate and better response rate after 16 and 24 months compared to standard treatment. The survival rate for treating B-cell lymphomas with Kimriah® was also higher than with standard therapy. The survival rate for treating B-cell leukaemia with Kimriah® after 150 days was not higher than with conventional chemotherapy. The meaningfulness of the available study data in terms of effectiveness and safety is very low in general. There is considerable uncertainty regarding the cost-benefit calculations. The extra costs for Kimriah® were between CHF 70,634 and CHF 157,437 per extra year of life assuming full health, and between CHF 88,346 and CHF 102,220 for Yescarta®. Anticipated additional treatment costs for using Kimriah® against B-cell leukaemia come to CHF 2.5 million in 2023, increasing to CHF 2.7 million by 2027. Additional estimated B-cell lymphoma treatment costs with Kimriah® or Yescarta® are CHF 30 million in 2023 and CHF 49 million in 2027. Ethical questions arose regarding equality of access to therapy in addition to problems with referral, long waiting times and confirmation of the assumption of costs. Organisational issues included care between stages in the treatment process for persons undergoing therapy, managing the side effects of CAR-T cell therapies, provision of information to doctors as well as lower hospital expenses compared to stem cell transplants.
The report concludes that given the low study quality, the significance of the available data with regard to the effectiveness and safety of CAR-T cell therapies is in general very low. Furthermore, no reliable conclusions can be drawn about the cost-benefit ratio based on the available data.
