Fixed-Duration 1L CLL Treatment Reduces Long-Term Costs in the Real World

A fixed-duration treatment regimen yields lower health care costs in the long term for patients receiving first-line chronic lymphocytic leukemia (CLL) treatment, suggest real-world findings.

The study, which assessed the cost of a venetoclax (Venclexta; AbbVie and Genentech)–based regimen compared with treat-to-progression Bruton tyrosine kinase inhibitor (BTKi) treatment, found that the venetoclax-based regimen was associated with an approximate $8000 decrease in costs compared with the continuous treatment 6 months after the fixed-duration period.

“Although venetoclax is often assumed to have higher overall medical costs owing to the need for tumor lysis syndrome monitoring during the ramp-up phase (including metabolic testing and potentially inpatient hospitalization) and concomitant treatment with obinutuzumab for the first 6 months, our study revealed that in the first 12 months after treatment initiation, patients receiving VEN-O and BTKis actually have similar mean cumulative (~$170,000) and mean monthly (~$14,000) all-cause health care costs (despite having a larger comorbidity burden and higher rate of hospitalization prior to initiating treatment),” explained the researchers.

The study found that the venetoclax-based regimen was associated with an approximate $8000 decrease in costs compared with the continuous treatment 6 months after the fixed-duration period. | Image Credit: © everythingpossible - stock.adobe.com

The study relied on Medicare claims data for approximately 1700 Medicare patients from between 2016 to 2021, examining costs between months 0 and 12—reflecting the treatment duration period for venetoclax + obinutuzumab (VEN+O)—and between months 13 and 18—reflecting the 6 months after the completion of VEN+O treatment. Indirect costs of treatment were not accounted for in the analysis. Findings from the study were detailed in the Journal of Managed Care Specialty Pharmacy.

During months 0 to 12, risk-adjusted all-cause costs were similar between the 193 patients who received VEN+O ($13,887) and the 1577 patients who received a BTKi ($14,492). Although CLL-related physician-administered drug costs were higher for the venetoclax-based regimen due to the concurrent use of obinutuzumab, the increase balanced out the higher CLL-related pharmacy costs associated with the BTKi.

In the following 6 months, patients who had received VEN+O experienced a significant drop in all-cause total costs, with costs dropping to approximately $4462, a 67% reduction. The drop was largely attributable to the absence of prescription drug costs. During the same period, costs for BTKi treatment dropped 10%, with all-cause total costs coming to $13,051.

Notably, most patients receiving a BTKi in the study were receiving ibrutinib (Imbruvica; Pharmacyclics and Janssen Biotech), the first-generation BTKi that made the list of the first 10 therapies being negotiated by Medicare under the Inflation Reduction Act of 2022. In August, the Biden administration released the negotiated drug prices, including for ibrutinib, announcing that ibrutinib’s list price would drop 38% from nearly $15,000 to approximately $9000.²

“Depending on the price reduction negotiated for ibrutinib, the costs in the first 12 months may be lower for ibrutinib initiators compared with VEN-O users,” noted the researchers, at the time of their analysis.¹ “However, as discussed above, our results suggest that a long-term economic outlook is required by payers when comparing the cost-effectiveness of these 2 treatments given the long natural history of CLL. A reduced drug price for ibrutinib may not fully address the continuous costs that payers will incur with treat-to-progression BTKis vs the time-limited costs of fixed-duration treatments like venetoclax.”

With the recent addition of next-generation BTKis, including acalabrutinib (Calquence; AstraZeneca) and zanubrutinib (Brukinsa; BeiGene USA), the researchers suggest further research into pricing comparisons in the context of these newer agents. In the current study, just 12% of patients were receiving acalabrutinib and less than 1% were receiving zanubrutinib. In addition to improved efficacy, these newer BTKi agents have demonstrated improved safety profiles compared with ibrutinib,³ which could have implications for related costs.

References

1. Huntington SF, Manzoor BS, Jawaid D, et al. Real-world comparison of health care costs of venetoclax-obinutuzumab vs Bruton’s tyrosine kinase inhibitor use among US Medicare beneficiaries with chronic lymphocytic leukemia in the frontline setting. J Manag Care Spec Pharm. 2024;30(10):1106-1116. doi: 10.18553/jmcp.2024.24049.
2. IRA negotiated drug prices released. August 15, 2024. Accessed October 16, 2024. American Association for Cancer Research. https://aacrjournals.org/cdnews/news/1612/IRA-Negotiated-Drug-Prices-Released
3. AJMC^® Contributor. Next-gen BTKis show efficacy, safety edge over ibrutinib in real-world study. AJMC. June 7, 2024. Accessed October 16, 2024. https://www.ajmc.com/view/next-gen-btkis-show-efficacy-safety-edge-over-ibrutinib-in-real-world-setting