Chimeric antigen receptor-natural killer cell therapy in first-relapse epithelial ovarian cancer: an early health-economic evaluation in the Netherlands.

Abstract

To use early health economic modelling to evaluate the potential cost-effectiveness of adding a CAR-NK (chimeric antigen receptor-natural killer) cell therapy to standard of care (SOC) in patients with platinum-sensitive, high-grade epithelial ovarian cancer (EOC) at first recurrence in the Netherlands. A partitioned survival model was developed from the Dutch healthcare perspective with a lifetime horizon and 3-week cycles, including progression-free, recurrent-disease and dead health states. Treatment regimens, varying by mutation status (BRCA, homologous recombination deficiency or no mutation), were compared with the same regimen plus repeated CAR-NK cell infusion (CAR-NK strategy). Two cost scenarios (€15 000 and €20 000 per CAR-NK cell therapy cycle) were analyzed. Costs and effects were discounted at 3% and 1.5% annually. Scenario and multivariate sensitivity analyses were conducted. A cost-effectiveness threshold of €80 000 per QALY was applied. The SoC strategy yielded 2.47 QALYs and 3.2 life-years at €34 340 per patient. CAR-NK strategy would require 0.76-0.95 additional QALYs (1.00-1.25 life-years) to be cost-effective. This corresponds to median gains of 3.08 months in progression-free survival and 10.82-13.60 months in overall survival. Cost-effectiveness was most sensitive to CAR-NK cell therapy costs, survival gains and utility values. A CAR-NK cell therapy could become cost-effective for platinum-sensitive EOC. To achieve this, it would need to deliver substantial overall survival gains. Early economic modeling provides strategic guidance for development, identifies key drivers of value and informs clinical trial design under uncertainty.