Cost-effectiveness of ibrutinib as first-line therapy for chronic lymphocytic leukemia in older adults without deletion 17p

Abstract

Ibrutinib is a novel oral therapy that has shown significant efficacy as initial treatment of chronic lymphocytic leukemia (CLL). It is a high-cost continuous therapy differing from other regimens that are given for much shorter courses. Our objective was to evaluate the cost-effectiveness of ibrutinib for first-line treatment of CLL in patients older than age 65 years without a 17p deletion. We developed a semi-Markov model to analyze the cost-effectiveness of ibrutinib vs a comparator therapy from a US Medicare perspective. No direct comparison between ibrutinib and the best available treatment alternative, obinutuzumab plus chlorambucil (chemoimmunotherapy), exists. Therefore, we compared ibrutinib to a theoretical treatment alternative, which was modeled to confer the effectiveness of an inferior treatment (chlorambucil alone) and the costs and adverse events of chemoimmunotherapy, which would provide ibrutinib with the best chance of being cost-effective. Even so, the incremental cost-effectiveness ratio of ibrutinib vs the modeled comparator was $189 000 per quality-adjusted life-year (QALY) gained. To reach a willingness-to-pay threshold (WTP) of $150 000 per QALY, the monthly cost of ibrutinib would have to be at most $6800, $1700 less than the modeled cost of $8500 per month (a reduction of $20 400 per year). When the comparator efficacy is increased to more closely match that seen in trials evaluating chemoimmunotherapy, ibrutinib costs more than $262 000 per QALY gained, and the monthly cost of ibrutinib would need to be lowered to less than $5000 per month to be cost-effective. Ibrutinib is not cost-effective as initial therapy at a WTP threshold of $150 000 per QALY gained.

Ibrutinib as a Potential Therapeutic for Cocaine Use Disorder

“…Our study benchmarked potential CUD medications against current targets in clinical trials, although we did not have data on various pharmaceuticals that have demonstrated some efficacy for individuals with CUD (e.g., disulfiram 46 ; topiramate 47 ). The lead repurposable drug from this study, Ibrutinib, may not be an accessible treatment option to many, as it can be costly 48 and may be associated with side effects 49 . In addition, it is unknown what dose would be most effective and whether negative health consequences arise when combining this medication with cocaine (or crack cocaine).…”

Health-related quality of life and economic burden of chronic lymphocytic leukemia in the era of novel targeted agents

“…A majority of economic studies on ibrutinib were studies evaluating the cost-effectiveness and budget impact of ibrutinib versus chemoimmunotherapy [52][53][54][55] . These models reported that while ibrutinib offered significant efficacy advantages over chemoimmunotherapy, such benefits came at a high cost to payers as a result of continuous therapy.…”

Chemoimmunotherapy in the First-Line Treatment of Chronic Lymphocytic Leukaemia: Dead Yet, or Alive and Kicking?

“…For example, the median duration of initial ibrutinib therapy in 89 patients with TP53 aberration (an indication which, due to the highest benefit vs. CIT, has the widest international availability in terms of reimbursement) was 46 months [63]; median treatment duration with acalabrutinib in the ELEVATE-TN was 28 months [82]. Several publications dealing with the economic burden and cost-effectiveness of ibrutinib concluded that despite undeniable excellent efficacy, ibrutinib was not cost-effective in comparison to chemoimmunotherapy [106,107]. Indeed, a recent study estimated that ibrutinib used in the first-line scenario was associated with the cost of USD 2.35 million per quality-adjusted life-year (QALY) and so would have to be cheaper by 72% in order to be cost-effective by reaching the willingness-to-pay (WTP) threshold of 150,000 USD/QALY, as accepted in the United States [108]; the WTP in European countries is considerably less, e.g., roughly USD 42,000 (GBP 30,000) in the United Kingdom.…”