OBJECTIVES: To estimate the cost-effectiveness of epcoritamab compared to available treatment alternatives for treating relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) after at least two lines of systemic therapy in Greece.

METHODS: A partitioned survival model, with three different health states (progression-free survival [PFS], post-progression survival, and death), was locally adapted from a Greek payer perspective over a lifetime horizon. Epcoritamab was compared to rituximab-based chemoimmunotherapy (R-CIT), polatuzumab vedotin with bendamustine plus rituximab (pola+BR), glofitamab, and tafasitamab plus lenalidomide (tafa+len) as well as to chimeric antigen receptor T-cell (CAR-T) therapies of axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel). Since the pivotal epcoritamab trial, EPCORE NHL-1, is a single-arm trial, matching-adjusted indirect comparisons were employed to generate comparative efficacy evidence against these comparators. Safety and utility data were extracted from the EPCORE-NHL-1 trial and literature. Direct costs pertaining to drug acquisition, administration, monitoring, adverse events, and terminal care were considered in the analysis. All cost inputs were indexed to 2024 euros. Primary outcomes were patients’ quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs). All future outcomes were discounted at 3.5% per annum. Sensitivity analyses were conducted.

RESULTS: Compared to R-CIT, pola+BR, glofitamab, and tafa+len, epcoritamab was found to be more effective (QALY gains: 2.744, 2.799, 0.916, and 1.724, respectively) and cost-effective (ICERs: €41,539, €28,681, €65,600, and dominant, respectively). In patients eligible for CAR-T therapies, epcoritamab was found to be a dominant treatment compared to both axi-cel and tisa-cel (versus axi-cel: less costly by €71,843 and more effective by 0.838 QALYs; versus tisa-cel: less costly by €60,307 and more effective by 2.416 QALYs). Sensitivity analyses confirmed the robustness of base-case results.

CONCLUSIONS: Epcoritamab was estimated to be the most effective and cost-effective therapy compared to all other available therapies for patients with R/R DLBCL in the third line treatment setting in Greece.