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Diffuse large B-cell lymphoma is the most common subtype of lymphoma. First-line treatment with combination chemoimmunotherapy is successful in about 60% of patients. For those who have relapse, second-line therapy consists of additional chemoimmunotherapy followed by autologous stem cell transplant. But most of these patients do not have good outcomes. The U.S. Food and Drug Administration (FDA) has approved CD19-directed chimeric antigen receptor T-cell therapy (CAR-T) for third-line treatment; CAR-T is also effective for relapsed disease. The study described in this article examines whether CAR-T could be used as second-line therapy. Visual Abstract. Second-Line Chimeric Antigen Receptor T-Cell Therapy in Diffuse Large B-Cell Lymphoma: Diffuse large B-cell lymphoma is the most common subtype of lymphoma. First-line treatment with combination chemoimmunotherapy is successful in about 60% of patients. For those who relapse, second-line therapy consists of additional chemoimmunotherapy followed by autologous stem cell transplant. But most of these patients do not have good outcomes. The U.S. Food and Drug Administration (FDA) has approved CD19-directed chimeric antigen receptor T-cell therapy (CAR-T) for third-line treatment; CAR-T is also effective for relapsed disease. The study described in this article examines whether CAR-T could be used as second-line therapy. Background: First-line treatment of diffuse large B-cell lymphoma (DLBCL) achieves durable remission in approximately 60% of patients. In relapsed or refractory disease, only about 20% achieve durable remission with salvage chemoimmunotherapy and consolidative autologous stem cell transplantation (ASCT). The ZUMA-7 (axicabtagene ciloleucel [axi-cel]) and TRANSFORM (lisocabtagene maraleucel [liso-cel]) trials demonstrated superior event-free survival (and, in ZUMA-7, overall survival) in primary-refractory or early-relapsed (high-risk) DLBCL with chimeric antigen receptor T-cell therapy (CAR-T) compared with salvage chemoimmunotherapy and consolidative ASCT; however, list prices for CAR-T exceed $400 000 per infusion. Objective: To determine the cost-effectiveness of second-line CAR-T versus salvage chemoimmunotherapy and consolidative ASCT. Design: State-transition microsimulation model. Data Sources: ZUMA-7, TRANSFORM, other trials, and observational data. Target Population: "High-risk" patients with DLBCL. Time Horizon: Lifetime. Perspective: Health care sector. Intervention: Axi-cel or liso-cel versus ASCT. Outcome Measures: Incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (iNMB) in 2022 U.S. dollars per quality-adjusted life-year (QALY) for a willingness-to-pay (WTP) threshold of $200 000 per QALY. Results of Base-Case Analysis: The increase in median overall survival was 4 months for axi-cel and 1 month for liso-cel. For axi-cel, the ICER was $684 225 per QALY and the iNMB was −$107 642. For liso-cel, the ICER was $1 171 909 per QALY and the iNMB was −$102 477. Results of Sensitivity Analysis: To be cost-effective with a WTP of $200 000, the cost of CAR-T would have to be reduced to $321 123 for axi-cel and $313 730 for liso-cel. Implementation in high-risk patients would increase U.S. health care spending by approximately $6.8 billion over a 5-year period. Limitation: Differences in preinfusion bridging therapies precluded cross-trial comparisons. Conclusion: Neither second-line axi-cel nor liso-cel was cost-effective at a WTP of $200 000 per QALY. Clinical outcomes improved incrementally, but costs of CAR-T must be lowered substantially to enable cost-effectiveness. Primary Funding Source: No research-specific funding. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.04.061 Byline: Majanka H. Heijenbrok-Kal (a)(b), Kirsten E. Fleischmann (c), M.G. Myriam Hunink (a)(b)(d) Abstract: Many studies have been published on the diagnostic performance of noninvasive tests for the assessment of coronary artery disease. The objective of the present study was to compare the published literature on the diagnostic performance of stress echocardiography, stress single-photon-emission computed tomography (SPECT), and electron beam computed tomography (EBCT). Author Affiliation: (a) Program for the Assessment of Radiological Technology (ART Program), Department of Epidemiology and Biostatistics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (b) Department of Radiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands (c) Cardiology Division, University of California, Medical Center, San Francisco, CA (d) Department of Health Policy and Management, Harvard School of Public Health, Boston, MA Article History: Received 20 February 2006; Accepted 29 April 2007 Article Note: (footnote) Financial support for this study was provided by a Program Grant (904-66-091) from the Netherlands Organization for Scientific Research and by a grant from the American Society of Echocardiography.

Background: Bone bruise is often seen in posttraumatic knees, but the clinical relevance is unclear. Hypothesis: The presence of bone bruise is associated with increased pain severity in patients with [...]

Clinical journals increasingly illustrate uncertainty about the cost and effect of health care interventions using cost-effectiveness acceptability curves (CEACs). CEACs present the probability that each competing alternative is optimal for [...]

Objective. To determine the apparent and internal validity of the Rotterdam Ischemic heart disease & Stroke Computer (RISC) model, a Monte Carlo-Markov model, designed to evaluate the impact of cardiovascular [...]

A study aimed to validate and compare the Canadian Computed Tomography (CT) Head Rule (CCHR) and the New Orleans Criteria (NOC) in Dutch patients with head injuries. Results indicated that for patients with minor head injury and a Glasgow Coma Scale (GCS) of 13 to 15, the CCHR had a lower sensitivity than the NOC for neurocranial traumatic or clinically important CT findings, but would identify all cases requiring neurosurgical intervention and had greater potential for reducing the use of CT scans.

Aspirin is a cost-effective method for preventing a second heart attack but the anticoagulant drug clopidogrel is not. However, clopidogrel could still be used by patients who cannot take aspirin.