Study Shows Bendamustine is Cost-Effective for Patients with CLL

Results of a pharmacoeconomic analysis showed that single-agent bendamustine is a cost-effective treatment option as first-line treatment for patients with Binet stage B or C chronic lymphocytic leukemia (CLL) compared to alemtuzumab and chlorambucil [Clinicoecon Outcomes Res. 2014;6:141-149].

Few studies have assessed the cost-effectiveness of first-line treatments for CLL, despite data showing a significant increase in Medicare costs between 1998 and 2002 for patients with CLL compared to Medicare patients without a cancer diagnosis. To fill this gap, the researchers used a discrete event simulation of the disease course of Binet stage B or C CLL to estimate and evaluate the cost-effectiveness and health benefits of first-line single-agents.

A hypothetical simulated patient population was created using data from clinical trials of CLL. In the simulation, patients were assigned to 1 of 3 treatment cohorts: (1) bendamustine (100 mg/m² per day intravenously on days 1 and 2 of each 28-day cycle for up to 6 cycles); (2) alemtuzumab (30 mg intravenously 3 times per week for up to 12 weeks); or (3) chlorambucil (0.8 mg/kg per day orally on days 1 and 15 of each 28-day cycle for up to 12 cycles).

Data from clinical trials were also used to create simulated risk equations for progression-free survival and survival after disease progression, response rates, and rates of adverse events. Each patient was assigned treatment-specific inputs that included overall response and risk of adverse events.

Outcomes included estimated survival rates (ie, life-years), quality-adjusted life-years (QALYs), adverse events, and associated direct medical costs estimated over the course of a patient’s lifetime. Costs, in 2012 US dollars, and health outcomes were discounted at 3% per year, and incremental cost-effectiveness ratios were calculated and expressed as cost per life-year or cost per QALY gained.

The study found that bendamustine was associated with the best health outcomes compared to either alemtuzumab or chlorambucil in life-years (6.1 vs 5.37 and 5.21, respectively), which represented a gain of 0.57 QALYs per patient in those treated with bendamustine compared to alemtuzumab (4.02 vs 3.45 QALYs, respectively) and a gain of 0.72 QAYs per patient in those treated with bendamustine compared to chlorambucil (4.02 vs 3.3 QALYs, respectively).

Progression-free survival was also longer in the patients treated with bendamustine compared to alemtuzumab or chloramubucil (24 months vs 15 months and 11 months, respectively).

Bendamustine was associated with lower cumulative costs compared to alemtuzumab ($78,776 vs $121,441, respectively), and higher costs compared to chlorambucil ($78,776 vs $42,337, respectively). Cumulative costs included treatment and administration, premedications, concomitant medications, routine care, and inpatient and outpatient care.

The differences in cost among these therapies, according to the study’s authors, were mainly due to the cost of initial treatment, administrative costs, and inpatient care.

In terms of cost-effectiveness, bendamustine was associated with an incremental cost-effectiveness ratio of $40,971 per life-year gained and $50,619 per QALY gained compared with chlorambucil.

According to the study’s authors, these incremental cost-effectiveness ratios associated with bendamustine compare favorably with median incremental cost-effectiveness ratios seen with other therapies for hematologic cancers and argue in favor of considering bendamustine as a cost-effective therapy for patients with CLL.

Overall, the study showed greater health benefits with bendamustine compared to alemtuzumab and chlorambucil in treatment-naïve patients with CLL and cost savings compared to alemtuzumab. Despite the higher costs of bendaustine compared to chlorambucil, bendamustine can be considered cost-effective compared to chlorambucil based on the better healthcare outcomes and acceptable cost.

Limitations of the study highlighted by the authors included the inability to fully incorporate into the simulation the impact of adverse events and infections on quality of life, the younger age of the patients in the selected studies used in the simulation compared to patients typically seen in real-world clinical settings, and the data from clinical trials completed under treatment conditions cannot always be duplicated in real-world settings.