Budget Impact of 12-Month Fixed Treatment Duration Venetoclax in Combination with Obinutuzumab in Previously Untreated Chronic Lymphocytic Leukemia Patients in the United States

• Published in: PharmacoEconomics 2020-09, Vol.38 (9), p.941-951
• Main Authors: Cho, Sang Kyu, Manzoor, Beenish S., Sail, Kavita R., Parisé, Hélène, Ravelo, Arliene, Shapouri, Sheila, Kapustyan, Tatyana, Sharmokh, Simon, Virabhak, Suchin, Davids, Matthew S., Johnson, Scott
• Format: Article
• Language: English
• Subjects: Analysis; Chronic lymphocytic leukemia; Cost control; Drug dosages; Drug therapy; Health Administration; Health Economics; Health maintenance organizations; Health technology assessment; HMOs; Immunotherapy; Leukemia; Market shares; Medical care, Cost of; Medical prognosis; Medicare; Medicine; Medicine & Public Health; Monoclonal antibodies; Original Research Article; Pharmacoeconomics and Health Outcomes; Public Health; Quality of Life Research; Targeted cancer therapy
• ISSN: 1170-7690; 1179-2027
• DOI: 10.1007/s40273-020-00919-1

Objectives This study aimed to assess the total cost of care (TCC) and budget impact of introducing 12-month fixed duration venetoclax + obinutuzumab (VEN+G) as first-line treatment for chronic lymphocytic leukemia (CLL) from the perspective of a US health plan with 1,000,000 (1M) members. Methods The 3-year model included the following comparators: fludarabine + cyclophosphamide + rituximab (FCR), bendamustine + rituximab (BR), obinutuzumab + chlorambucil (GClb), ibrutinib (Ibr), and Ibr+Rituximab/obinutuzumab [Ibr+R/Ibr+G]). TCC included US-specific costs associated with treatment (i.e., drug, administration, and wastage), adverse events, routine care, and monitoring. Dosing and safety data were drawn from clinical trials and US package inserts. Budget impact outcomes were presented on an absolute and per-member per-month (PMPM) basis. Sensitivity analyses explored uncertainty in influential parameters, including scenarios testing the duration of treat-to-progression agents. Results Over the 3-year time horizon, introducing VEN+G in a 1M-member health plan resulted in total cost savings of $1,550,663 (PMPM − $0.04), compared to a scenario without VEN+G. The fixed 12-month duration of VEN+G contributed to this cost saving by reducing cumulative treatment costs compared with Ibr-based regimens. By year 3, the cumulative difference in TCC of VEN+G compared with Ibr, Ibr+G, and Ibr+R amounted to − $300,942, − $367,001, and − $369,784, respectively. Extensive sensitivity analyses supported the base case findings. Conclusions Introducing VEN+G among first-line CLL treatments to a US health plan resulted in cost savings compared to a plan with chemoimmunotherapies and Ibr-based therapies only. Economic benefits of VEN+G, a novel agent with fixed treatment duration, coupled with proven clinical benefits should help inform formulary adoption decisions and treatment recommendations.