Comparing the Cost-Effectiveness of First-Line Treatments of Chronic Lymphocytic Leukemia

Findings from a recent study suggest that when compared with venetoclax-plus-obinutuzumab, chemoimmunotherapies are associated with less health benefits at higher cost, and that the targeted therapies achieve greater benefits at higher cost (Value Health. 2022; S1098-3015(22)00196-6. doi:10.1016/j.jval.2022.04.001).

There are many chemoimmunotherapy and targeted treatment regimens available as front-line therapies in chronic lymphocytic leukemia (CLL), and this study aimed to identify the cost-effectiveness and economic burden among all first-Line treatments of CLL.

“We estimated for the 10-year cost-effectiveness of these treatment regimens and the economic burden of following the estimated risk-stratified 21,040 patients with CLL diagnosed in 2020 for 10 years,” wrote Neda Alrawashdh, PhD, Center for Health Outcomes and PharmacoEconomic Research, Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, and colleagues.

Dr Alrawashdh and colleagues constructed a Markov model with 7 exclusive health states over a 10-year time horizon. A novel network meta-analysis on the progression-free survival, overall survival curves, and time to next treatment informed data on treatment effectiveness. Costs and utilities inputs were included for health states and treatments and discounted at 3.0% per year.

Venetoclax-plus-obinutuzumab was the lowest cost regimen and more effective than all chemoimmunotherapies. Though it was the most expensive regimen, Acalabrutinib-plus-obinutuzumab had the highest effectiveness gains at 6.26 life-years (LYs) and 5.01 quality-adjusted life years (QALYs), and it yielded the best incremental cost-effectiveness ratio (ICER; $409,343/LY gained) and ICUR (incremental cost-utility ratio; $501,236/QALY gained). 

“The remaining ICERs of targeted therapies ranged from $512,101/LY gained to $793,236/LY gained and the ICURs from $579,737/QALY gained to $869 300/QALY gained,” the researchers wrote, adding, “The 10-year postdiagnosis low/high (venetoclax-plus-obinutuzumab/acalabrutinib-plus-obinutuzumab) economic burden ranges were $42,690 to $98,665 for low-risk, $141,339 to $326,660 for intermediate-risk, and $273,650 to $632,453 for high-risk patients.”

“Compared with venetoclax-plus-obinutuzumab, chemoimmunotherapies are associated with less health benefits at higher cost,” concluded Dr Alrawashdh and colleagues.