Currently, there are many treatment options for the first and second-line management of chronic lymphocytic leukemia (CLL). With high-priced targeted therapies such as ibrutinib for the second-line management of CLL, it becomes crucial to identify the best sequencing scenario and ensure that health care resources are best utilized. The purpose of this analysis was to estimate the budget impact of different sequencing scenarios for the treatment of first and second-line patients with CLL.
A literature search was performed to identify clinical trials on the first-line management of CLL. Data on the median progression free survival (PFS) were extracted from these trials. The Canadian drug treatment cost was also estimated for each first line treatment of interest with the addition of ibrutinib as the second-line treatment option. An average budget impact per year was estimated over a 5-year period for each treatment sequence scenario.
A total of 8 clinical trials on the first-line treatment of CLL were identified. Patient characteristics were variable in the studies. Estimated average annual budget impact was the lowest for the bendamustine + rituximab / ibrutinib sequence at $42,992, followed by chlorambucil + obinutuzumab / ibrutinib at $58,974, bendamustine monotherapy / ibrutinib at $69,889, chlorambucil + rituximab / ibrutinib at $78,236 and chlorambucil monotherapy / ibrutinib at $79,508. Finally, the use of ibrutinib only, as first line therapy without any preceding treatment, was the most costly at $99,262.
Based on this analysis it may be concluded that the best first-line option for the management of patients with CLL, when considering the cost of ibrutinib as second-line treatment option, is bendamustine + rituximab as this combination offers the best budget impact with the lowest cost per year. The advantage of this combination in first-line is that it delays second-line treatment with costly ibrutinib.
© 2016 Published by Elsevier Inc.