Cost-Effectiveness Comparison between Ibrutinib, Chemotherapy, and Chemoimmunotherapy in Front-Line Treatment of Chronic Lymphocytic Leukemia (CLL)

• Published in: Blood 2018-11, Vol.132 (Supplement 1), p.4757-4757
• Main Authors: Nabhan, Chadi, Nero, Damion, Lee, Choo Hyung, Kish, Jonathan K., Mato, Anthony R.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2018-99-118640

INTRODUCTION: CLL pts requiring first-line therapy are usually treated with either ibrutinib, chemotherapy alone including monoclonal antibodies (CT), or chemoimmunotherapy (CIT). In the absence of prospective efficacy data comparing CIT with ibrutinib, treatment selection depends on risk stratification, comorbidities, age, goals of therapy, pt preference, and physician familiarity with regimens. When all factors are equal, costs and economics might influence treatment choice especially in a value-based care environment. We performed a cost-comparative analysis between ibrutinib, CT, and CIT-treated CLL pts in the first line aiming to provide additional guidance for clinicians when deciding on initial therapy. PATIENTS and METHODS: This is a retrospective, observational study of CLL pts treated in the first line with ibrutinib, CT, or CIT. Primary end-point was to compare healthcare resource utilization (HRU) between pts in each cohort. Secondary objective was to quantify the incidence of cardiovascular (CV) adverse events between pts who did not have any CV disease prior to treatment initiation. Pts were extracted from Symphony Health's Integrated Dataverse (IDV) between 1/1/2014-12/31/2017. The database is representative of the U.S. population across age, sex, geography, and insurance type. Pts were ≥18 years at diagnosis and initiated therapy after 1/1/2014 and before 11/30/2017 to allow for at least 3 months of follow up. Pts were required to have no CV events during the 12-month period before study entry. CV events included hypertension (HTN), myocardial infarction (MI), atrial fibrillation (Afib), peripheral vascular disease (PVD) and coronary artery disease (CAD). HRU was evaluated using admission codes for hospitalization, emergency room (ER), office visits, and other outpatient visits. Direct medical costs were calculated based on standardized costs and were estimated in US dollars as per patient per month. Comparisons of HRU and costs and the proportion of pts with a CV event were performed using the chi square or Fisher exact test for proportions and the t-test or Wilcoxon rank sum test for continuous data. Fisher exact test and the Wilcoxon rank-sum test were used in cases where the data did not have a normal distribution. The Kruskal-Wallis test was used in cases where multiple groups were being compared. RESULTS: The final cohorts included 4,368 pts receiving ibrutinib, 1,464 receiving CT, and 2,176 treated with CIT (1,523 BR, 634 FCR, and 19