Drivers of Cost Savings for Revumenib for Rare Acute Leukemias: Ivo Abraham, PhD, RN

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Despite being a highly specialized treatment, the first-in-class targeted therapy revumenib (Revuforj; Syndax Pharmaceuticals) for relapsed/refractory acute leukemias with a KMT2A translocation should be cost-neutral over a 3-year period for health plans. This surprising balance is attributed to a combination of cost savings and carefully managed uptake, explained Ivo Abraham, PhD, RN, professor, Department of Pharmacy Practice and Science, R. Ken Coit College of Pharmacy, The University of Arizona, the lead author on a recently published budget impact analysis for revumenib.

A primary driver of cost savings is that revumenib is administered orally.

"First of all, [revumenib is] a pill, so it's patient-administered. You're already not having the cost of chemotherapy administration or [intravenous] administration, which means several hours in a chair, and then the additional administration costs that that may be incurred." This eliminates significant expenses associated with clinic visits, chair time, and direct administration costs, which are substantial for infusion-based therapies. Although patients living longer on revumenib does introduce additional costs for ongoing care, these are largely offset by the reduced burden of adverse events and their associated management.

Anticipating real-world factors that could influence revumenib's uptake, building clinician confidence in the therapy is paramount. While payers ultimately influence formulary decisions, they typically follow clinical evidence and the guidance of medical professionals and key opinion leaders. Therefore, educating and convincing clinicians about revumenib's efficacy and safety profile will be crucial for its adoption, Abraham said.

In addition, patient adherence is a critical variable since this is an oral therapy. Although good adherence leads to better patient outcomes and continued cost-effectiveness, nonadherence could accelerate disease progression, potentially leading to increased costs in the long run.

“But the argument here is, if you treat the patient, you're going to have [good] patient quality of life—comfort—[and] no chemotherapy. There's a little bit of risk,” Abraham said. “We know that not all patients take their pills, so you have to hope that you have adherent patients, but if they are adherent, they will do well.”