Exploring the Cost-Effectiveness of Acalabrutinib Regimens for Treatment-Naive CLL

Acalabrutinib monotherapy is likely to be a cost-effective treatment option compared to chlorambucil plus obinutuzumab for treatment-naïve patients with chronic lymphocytic leukemia (CLL), according to recent findings published in Expert Review of Pharmacoeconomics & Outcomes Research.

Targeted therapies for CLL have demonstrated significant improvements in clinical outcomes for patients, researchers said. In this study, researchers aimed to evaluate the cost-effectiveness of acalabrutinib, either alone or in combination with obinutuzumab, compared to the standard treatment of chlorambucil plus obinutuzumab for treatment-naive CLL patients.

To assess cost-effectiveness, the researchers used a semi-Markov model with 3 health states: progression-free, progressed disease, and death. The model considered a 30-year lifetime horizon and estimated the cost per quality-adjusted life-year (QALY) gained for each treatment option. The analysis was conducted from the perspective of the US Medicare system, considering direct costs and resource utilization. 

The base case analysis revealed that acalabrutinib monotherapy provided an incremental cost of $206,329 with 2.52 QALYs gained compared to chlorambucil plus obinutuzumab. This resulted in an incremental cost-effectiveness ratio (ICER) of $81,960/QALY. On the other hand, acalabrutinib plus obinutuzumab showed an incremental cost of $423,747 with 2.79 QALYs gained (ICER: $152,153/QALY).

With a willingness-to-pay threshold of $100,000 to $150,000/QALY, the probabilistic sensitivity analysis showed that acalabrutinib monotherapy had a 59% to 73% probability of being cost-effective, while acalabrutinib plus obinutuzumab had a 34% to 51% probability of being cost-effective.

The researchers acknowledged that the analysis was subject to some limitations, particularly the uncertainty in postprogression survival outcomes. However, despite these limitations, the study's findings suggest that acalabrutinib monotherapy is likely to be a cost-effective treatment option, researchers said.

“The results from our model may be utilized by US payers and decision-makers involved in CLL treatment selection, particularly in the US Medicare setting. The evidence and methods described here may also inform future economic analyses in CLL,” investigators concluded.

Reference:
Munir T, Genovez V, Genestier V, Ryan K, Liljas B, Gaitonde P. Cost-effectiveness of acalabrutinib regimens in treatment-naïve chronic lymphocytic leukemia in the United States. Expert Rev Pharmacoecon Outcomes Res. 2023;23(5):579-589. doi:10.1080/14737167.2023.2196408