Cost-effectiveness of axicabtagene ciloleucel versus tisagenlecleucel for the treatment of 3L + relapsed/refractory large B-cell lymphoma in the United States: incorporating longer survival results.

AIMS: To provide an update on the cost-effectiveness of the chimeric antigen receptor (CAR) T-cell therapies axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) for the treatment of relapsed/refractory (r/r) large B-cell lymphoma (LBCL) among patients who have previously received ≥2 lines of systemic therapy using more mature clinical trial data cuts (60 months for axi-cel overall survival [OS] and 45 months for tisa-cel OS and progression-free survival [PFS]). METHODS: A partitioned survival model consisting of three health states (pre-progression, post-progression and death) was used to estimate quality-adjusted life years (QALYs) and costs associated with axi-cel and tisa-cel over a lifetime horizon. PFS and OS inputs for axi-cel and tisa-cel were based on a previously published matching-adjusted indirect treatment comparison (MAIC). Long-term OS and PFS were extrapolated using parametric survival mixture cure models (PS-MCMs). Costs of CAR-T cell therapy drug acquisition and administration, conditioning chemotherapy, apheresis, CAR T-specific monitoring, stem cell transplant, hospitalization, adverse events, routine care, and terminal care were sourced from US cost databases. Health state utilities were derived from previous publications. Model inputs were varied using a range of sensitivity and scenario analyses. RESULTS: Compared with tisa-cel, axi-cel resulted in 2.51 additional QALYs and $50,185 additional costs (an incremental cost-effectiveness ratio [ICER] of $19,994 per QALY gained). In probabilistic sensitivity analysis (PSA), the ICER for axi-cel versus tisa-cel was ≤$50,000/QALY in 99.4% of simulations and ≤$33,500 in 99% of simulations. Axi-cel remained cost-effective versus tisa-cel (assuming a willingness-to-pay threshold of $150,000 per QALY) across a range of scenarios. CONCLUSIONS: With longer-term survival data, axi-cel continues to represent a cost-effective option versus tisa-cel for treatment of r/r LBCL among patients who have previously received ≥2 lines of systemic therapy, from a US payer perspective.

Assessing the role of an artificial intelligence assessment tool for thoracic aorta diameter on routine chest CT.

OBJECTIVE: To assess the diagnostic accuracy and clinical impact of automated artificial intelligence (AI) measurement of thoracic aorta diameter on routine chest CT. METHODS: A single-centre retrospective study involving three cohorts. 210 consecutive ECG-gated CT aorta scans (mean age 75 ± 13) underwent automated analysis (AI-Rad Companion Chest CT, Siemens) and were compared to a reference standard of specialist cardiothoracic radiologists for accuracy measuring aortic diameter. A repeated measures analysis tested reporting consistency in a second cohort (29 patients, mean age 61 ± 17) of immediate sequential pre-contrast and contrast CT aorta acquisitions. Potential clinical impact was assessed in a third cohort of 197 routine CT chests (mean age 66 ± 15) to document potential clinical impact. RESULTS: AI analysis produced a full report in 387/436 (89%) and a partial report in 421/436 (97%). Manual vs AI agreement was good to excellent (ICC 0.76-0.92). Repeated measures analysis of expert and AI reports for the ascending aorta were moderate to good (ICC 0.57-0.88). AI diagnostic performance crossed the threshold for maximally accepted limits of agreement (>5 mm) at the aortic root on ECG-gated CTs. AI newly identified aortic dilatation in 27% of patients on routine thoracic imaging with a specificity of 99% and sensitivity of 77%. CONCLUSION: AI has good agreement with expert readers at the mid-ascending aorta and has high specificity, but low sensitivity, at detecting dilated aortas on non-dedicated chest CTs. ADVANCES IN KNOWLEDGE: An AI tool may improve the detection of previously unknown thoracic aorta dilatation on chest CTs vs current routine reporting.

An assessment of a portable cyanoacrylate fuming system (LumiFume™) for the development of latent fingermarks.

The effectiveness and suitability of a portable cyanoacrylate fuming system (LumiFume™) with Lumicyano™ at detecting latent fingermarks was assessed. The first phase of the study compared the LumiFume™ system with traditional cabinet fuming and black/white powder suspension for the development of latent fingermarks on a variety of surfaces (glass, plastic bin bag, laminated wood and tile) by means of depletion series' from 10 donors and four ageing periods (1, 7, 14 and 28 days). The portable fuming system provided superior quality of developed marks on glass and laminated wood whereas powder suspension was better on bin bags and all three techniques were comparable on tile. A decrease in mark quality was recorded from 1 to 14 days for the fuming techniques before an increase at 28 days. Lumicyano™ fluorescence stability studies over a 28 day period by means of depletion series' on glass slides and plastic bin bags revealed better quality marks for the portable system LumiFume™; however, storing marks under light conditions expedited deterioration for both systems. All marks developed with Lumicyano™ were subsequently treated with BY40 resulting in further improvement in mark quality for all substrates and ageing periods, with the exception of laminated wood which absorbed the fluorescent stain reducing the contrast in the process. The second phase of the study consisted of a pseudo-operational trial on 300 various substrates (e.g. glass bottles, aluminium cans, plastic bags) recovered from recycling bins. LumiFume™ and Lumicyano™ yielded 1469 marks whereas Lumicyano™ cabinet fuming and powder suspension yielded 1026 and 641 marks respectively. Similar to the first phase of the study, further treatment of the Lumicyano™ treated marks with BY40 resulted in further quality improvement as well as additional new marks. The LumiFume™ system produced results at least equivalent to the traditional cabinet fuming with Lumicyano™ highlighting its potential for implementation into casework to process crime scenes.