The pricing barrier: cost-effectiveness of Glofitamab for Relapsed/Refractory DLBCL in China beyond threshold and value-based pricing strategy considerations

To assess the cost-effectiveness of Glofitamab plus Gemcitabine and Oxaliplatin (Glofit-GemOx) versus Rituximab plus Gemcitabine and Oxaliplatin for treating relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) in China. A partitioned survival model utilized data from the phase 3 STARGLO trial, extrapolating progression-free survival and overall survival via parametric distributions. Costs and utilities were derived from Chinese databases and literature, covering drug expenses, adverse event management, and subsequent therapies. Incremental cost-effectiveness ratios (ICERs) were assessed against a willingness-to-pay (WTP) threshold of $40,343 per quality adjusted-life year (QALY). Sensitivity and budgetary impact analyses were conducted. Glofit-GemOx yielded an additional 1.47 QALYs (2.64 vs. 1.17) at an incremental cost of $92,765, resulting in an ICER of $63,379/QALY, exceeding the WTP threshold. Key drivers included Glofitamab’s price and utility parameters. Probabilistic sensitivity analysis showed a 14.5% probability of cost-effectiveness at the threshold. A 30% price reduction would be required to achieve cost-effectiveness. The five-year budget impact analysis projected sustained and substantial incremental costs associated with Glofit-GemOx. Although Glofit-GemOx offers significant survival benefits, it is not cost-effective in China at current prices. Price reductions or insurance coverage could improve accessibility, supporting the need for value-based pricing strategies.