Advances in the understanding of the biology of chronic lymphocytic leukemia (CLL) have led to the development of new targeted therapies. Although there have been several trials evaluating different treatment regimens for the first-line treatment of CLL, direct comparisons between active treatments are limited. The purpose of this analysis was to estimate the cost-effectiveness of the different treatment options currently available.
A literature search was performed to identify all phase 3 clinical trials that were conducted in first-line CLL. Treatments selected for this economic evaluation were: bendamustine monotherapy, bendamustine + rituximab (BR), chlorambucil monotherapy (CLB), chlorambucil + rituximab (CLB+R), chlorambucil + obinutuzumab (CLB+OBI) and chlorambucil + ofatumumab (CLB+OFA). Data on the median progression free survival (PFS) were extracted from these clinical trials. Canadian costs for each treatment modalities were estimated based both on the dosage used in clinical trials and current list prices. For each treatment modality cost-effectiveness ratios were calculated.
A total of 10 phase 3 clinical trials reporting PFS in first-line treatment of CLL were retrieved and analyzed. Inclusion criteria were variable. Reported median PFS for bendamustine monotherapy, BR, CLB, CLB+R, CLB+OBI and CLB+OFA were 21.2, 41.0, 12.1, 19.2, 29.5 and 22.4 months respectively. BR was the most effective treatment in terms of median PFS. Therefore, an incremental cost-effectiveness ratio (ICER) was calculated for each treatment strategy in comparison to BR. Estimated ICER for bendamustine monotherapy, CLB, CLB+R, CLB+OBI and CLB+OFA were respectively $13,373, $20,709, $13,771, $8,218 and $5,098 per life year saved.
Among first-line treatment options selected for this evaluation, the combination of BR may be the most efficacious combination with a median PFS of 41 months. Also, BR appears cost-effective for upfront therapy with ICERs in all cases, much below the usually accepted thresholds. Differences in the patients may impact our findings.
© 2016 Published by Elsevier Inc.