For patients receiving first-line treatment for chronic lymphocytic leukemia (CLL), real-world research suggests that fixed-duration treatment plans can reduce healthcare costs in the long term.
This study evaluated the cost of venetoclax (Venclexta, AbbVie and Genentech)-based regimens compared to Bruton’s tyrosine kinase inhibitor (BTKi) treatment from treatment to progression, with venetoclax-based regimens costing approximately $8,000. A cost reduction was found. The cost will be lower than if you continue treatment for 6 months after the fixed period ends.
“Venetoclax requires monitoring for tumor lysis syndrome during the start-up phase (including metabolic testing and possible hospitalization) and combination treatment with obinutuzumab for the first six months, resulting in higher overall healthcare costs. However, our study shows that in the first 12 months after starting treatment, patients receiving VEN-O and BTKis actually had similar average cumulative approximately $170,000) and has an average monthly fee. All-cause medical costs (approximately $14,000) (despite a high burden of comorbidities and high rates of hospitalization before treatment initiation),” the researchers explained.
The study found that venetoclax-based therapy reduced costs by approximately $8,000 compared to continuous treatment after 6 months of a fixed period. |Image credit: © everythingpossible – Stock.adobe.com
This study is based on Medicare claims data for approximately 1,700 Medicare patients from 2016 to 2021 and estimates costs from 0 to 12 months reflecting treatment duration of venetoclax plus obinutuzumab (VEN+O) and VEN +O 6 months after the end of treatment. Indirect costs of treatment were not considered in the analysis. For details of the research results, please see Managed Care Specialty Pharmacy Journal.
From months 0 to 12, risk-adjusted all-cause costs were similar for 193 patients who received VEN+O ($13,887) and 1,577 patients who received BTKi ($14,492) It was. Although CLL-related physician-administered drug costs were higher for venetoclax-based regimens with obinutuzumab, this increase offset higher CLL-related drug costs associated with BTKi.
Over the next 6 months, patients who received VEN+O experienced a significant reduction in all-cause total costs, with costs decreasing to approximately $4,462, a 67% reduction. This decrease was primarily due to lower prescription drug costs. Over the same period, the cost of BTKi treatment decreased by 10%, with a total all-cause cost of $13,051.
Of note, most of the patients who received BTKi in this study received ibrutinib (Imbruvica, Pharmacyclics and Janssen Biotech). This is the first generation BTKi to be on the list of the first 10 treatments being negotiated by Medicare under the Inflation Reduction Act of 2022. in augustthe Biden administration released negotiated drug prices including ibrutinib, announcing a 38% drop in ibrutinib’s list price from about $15,000 to about $9,000.2
“Depending on ibrutinib price negotiations, the initial 12-month cost of ibrutinib initiators could be lower compared to VEN-O users,” the researchers said in their analysis.1 “However, as discussed above, our results demonstrate that given the long natural history of CLL, payers need a long-term economic outlook when comparing the cost-effectiveness of these two treatments. This suggests that ibrutinib price reductions may not fully address the ongoing costs to payers of treatment-until-progression BTKis compared to the limited-time costs of fixed-duration treatments like venetoclax. There is.”
With the recent addition of next-generation BTKis such as acalabrutinib (Calquence; AstraZeneca) and zanubrutinib (Brukinsa; BeiGene USA), researchers suggest further study of price comparisons in the context of these new agents. In the current study, only 12% of patients received acalabrutinib and less than 1% received zanubrutinib. In addition to improved efficacy, these new BTKi agents have demonstrated improved safety profiles compared to ibrutinib.3 Related costs may be affected.
References
- Huntington SF, Manzoor BS, Jawaid D, et al. A real-world comparison of medical costs with the use of venetoclax obinutuzumab and Bruton’s tyrosine kinase inhibitor in U.S. Medicare beneficiaries with frontline chronic lymphocytic leukemia. J Manag Care Spec Farm. 2024;30(10):1106-1116. doi:10.18553/jmcp.2024.24049.
- Drug prices negotiated by the IRA have been announced. August 15, 2024. Accessed October 16, 2024. American Association for Cancer Research. https://aacrjournals.org/cdnews/news/1612/IRA-Negotiated-Drug-Prices-Limited
- AJMC® Posted by. Next-generation BTKi has shown better efficacy and safety than ibrutinib in real-world studies. 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
