Comparison of Time to Next Treatment, Health Care Resource Utilization, and Costs in Patients with Chronic Lymphocytic Leukemia Initiated on Front-line Ibrutinib or Chemoimmunotherapy

Abstract

Health care costs, health care resource utilization, and time to next treatment were compared among patients with chronic lymphocytic leukemia initiated on front-line ibrutinib single agent (N [ 322) or chemoimmunotherapy (N [ 839). Ibrutinib was associated with lower total health care costs driven by lower medical costs (despite higher pharmacy costs), and longer time to next treatment versus chemoimmunotherapy. Background: Studies assessing ibrutinib's economic burden versus chemoimmunotherapy (CIT) focused on pharmacy costs but not medical costs. This study compared time to next treatment (TTNT), health care resource utilization (HRU), and total direct costs among patients with chronic lymphocytic leukemia (CLL) initiating front-line ibrutinib single agent (Ibr) or CIT. Materials and Methods: Optum Clinformatics Extended DataMart De-Identified Databases were used to identify adults with ! 2 claims with a CLL diagnosis initiating front-line Ibr or CIT from February 12, 2014 to June 30, 2017. Inverse probability of treatment weighting was used to control for potential differences in baseline characteristics between the Ibr and CIT cohorts. Two periods were considered: entire front-line therapy (until initiation of second-line therapy) and first 6 months of front-line therapy. Comparisons with a subgroup of CIT patients initiating bendamustine/rituximab (BR) were also conducted. Results: TTNT was significantly longer for Ibr (N ¼ 322) relative to CIT (N ¼ 839; hazard ratio, 0.54; P ¼ .0163; Kaplan-Meier rates [24 months]: Ibr ¼ 88.6%, CIT ¼ 75.9%) and the subset of CIT patients treated with BR (N ¼ 455; hazard ratio, 0.54; P ¼ .0208; Kaplan-Meier rates [24 months]: Ibr ¼ 89.0%, BR ¼ 79.0%). During the entire front-line therapy, Ibr patients had significantly fewer monthly days with outpatient visits (rate ratio ¼ 0.75; P ¼ .

Budgetary Impact of Bendamustine Ready-to-Dilute Products in Chronic Lymphocytic Leukemia and Non-Hodgkin Lymphoma to a United States Infusion Facility

“…Real-world data suggest up to 50% of treated patients receive first-line BND. 23,[27][28][29] Given the high survival rate and CLL prevalence without supportive real-word data for relapsed treatment patterns annually, a patient count that is half the annual incidence may be used as a best-estimate and conservative proxy for the number of relapsed patients who will receive treatment in a given year. Therefore, the base-case population for patients with CLL who may receive BND-S or BND-L was calculated as 1.5%.…”

Time to Next Treatment as a Meaningful Endpoint for Trials of Primary Cutaneous Lymphoma

“…TTNT is a well-accepted endpoint in clinical trials of patients with multiple myeloma [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. It also features in the published literature of clinical studies of patients with chronic lymphocytic leukaemia [ 29 , 30 , 31 , 32 , 33 , 34 ], follicular lymphoma [ 35 , 36 , 37 , 38 , 39 ], mantle cell lymphoma [ 40 ], amyloidosis [ 41 ], Waldenstrom macroglobulinaemia [ 42 , 43 ], autoimmune haemolytic anaemia [ 44 ], metastatic melanoma [ 45 ], and metastatic breast cancer [ 46 ]. TTNT has also been used as a valid endpoint within cost-benefit analyses in several published health-economic analyses [ 19 , 24 , 27 , 29 ].…”

“…It also features in the published literature of clinical studies of patients with chronic lymphocytic leukaemia [ 29 , 30 , 31 , 32 , 33 , 34 ], follicular lymphoma [ 35 , 36 , 37 , 38 , 39 ], mantle cell lymphoma [ 40 ], amyloidosis [ 41 ], Waldenstrom macroglobulinaemia [ 42 , 43 ], autoimmune haemolytic anaemia [ 44 ], metastatic melanoma [ 45 ], and metastatic breast cancer [ 46 ]. TTNT has also been used as a valid endpoint within cost-benefit analyses in several published health-economic analyses [ 19 , 24 , 27 , 29 ]. Interestingly, the use of TTNT has also been applied to the use of positron emission tomography for the purposes of prognostication [ 23 , 39 ].…”

Time to Next Treatment, Health Care Resource Utilization, and Costs Associated with Ibrutinib Use Among U.S. Veterans with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Real-World Retrospective Analysis

“…The resource utilization and economic burden of CLL are significant, with monthly per-patient costs varying greatly by care setting, treatment regimen, and rate of adverse events (AEs). [21][22][23][24] Compared with 2011, the number of people living with CLL in the United States is expected to increase by more than 50% by 2025 due to improved treatment options and higher survival rates. 2,25 Given the limited real-world evidence of ibrutinib treatment among patients with CLL/SLL in the Veterans Administration (VA) population, the present study aimed to determine if treatment with ibrutinib single-agent in 1L was beneficial in extending time to next treatment (TTNT) when compared with 1L CIT and ibrutinib in the second and third line (2L+) among veterans with CLL/SLL.…”