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Cost-effectiveness of Venetoclax plus Obinutuzumab versus Chlorambucil plus Obinutuzumab for the First-Line Treatment of Adult Patients with Chronic Lymphocytic Leukemia – an extended societal view

  • Ngoc Do
    Correspondence
    Corresponding author: Ngoc Do, MSc, Erasmus School of Health Policy & Management, Erasmus University of Rotterdam, Rotterdam, the Netherlands, School of Speech, Language, ad Hearing Sciences, San Diego State University, San Diego, CA, USA, and [email protected], Phone: 858-305-9098
    Affiliations
    Erasmus School of Health Policy & Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
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  • Frederick Thielen
    Affiliations
    Erasmus School of Health Policy & Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
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Open AccessPublished:November 10, 2022DOI:https://doi.org/10.1016/j.jval.2022.11.002
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      Highlights

      • This is the first cost-effectiveness analysis (CEA) of venetoclax in combination with obinutuzumab (VenO) making available the full economic model following Open Science Practices to promote research transparency and reproducibility.
      • This is the first European CEA of VenO considering an extended societal view in scenario analyses including future non-medical costs and possible drug price changes upon their patent expiry.
      • VenO for adult, treatment-naïve CLL patients is cost-effective when compared to ClbO from a Dutch (extended) societal perspective, and this finding may be used to support decision-making in both clinical applications and reimbursement of VenO.

      Abstract

      Objectives

      Efficacy of venetoclax plus obinutuzumab (VenO) compared to chlorambucil plus obinutuzumab (ClbO) for treatment-naïve CLL adult patients with coexisting medical conditions was investigated in CLL14 (NCT02242942). Our aim was to evaluate the cost-effectiveness of VenO versus ClbO for these patients from a Dutch societal perspective.

      Methods

      A three-state partitioned survival model was constructed to evaluate the cost-effectiveness of VenO. The outcome of the analysis was the incremental cost-effectiveness ratio (ICER) with effectiveness measured in quality-adjusted life-years (QALYs) gained. Uncertainty was explored through deterministic and probabilistic sensitivity analyses (DSA & PSA), scenario analyses, and value of information analysis (VOI).

      Results

      The base case resulted in a discounted ICER -49,928 EUR/QALY gained (with incremental negative costs and positive effects). None of the ICERs resulted from DSA and scenario analyses exceeded the chosen willingness-to-pay threshold of 20,000 EUR/QALY, and more than 99% of the iterations in the PSA were cost-effective. VOI analyses showed a maximum expected value of eliminating all model parameter uncertainty of 183,591 EUR.

      Conclusions

      Our study demonstrated VenO being dominant over ClbO in adult, treatment naïve CLL assuming a Dutch societal perspective. We concluded that our results are robust as tested through sensitivity and scenario analyses. Additionally, the VOI analyses confirmed that our current evidence base is strong enough to generate reliable results for our study. However, further research based on real-world data or longer follow-up period could further contribute to the robustness of the current study’s conclusions.