First-Line Venetoclax Plus Obinutuzumab is Cost-Effective for Unfit Patients With CLL

Fixed duration venetoclax plus obinutuzumab for 12 months is a cost-effective first-line treatment option for unfit patients with chronic lymphocytic leukemia (CLL), according to results from an analysis published in the Journal of Managed Care and Specialty Pharmacy (2021;27[11]:1532-1544. doi:10.18553/jmcp.2021.27.11.1532).

“Most chemotherapy-free regimens require continuous treatment to progression, while [venetoclax plus obinutuzumab] is given for a fixed duration of 12 months, based on the CLL14 trial that led to its approval,” explained Anuja Chatterjee, PhD, Pharmerit – An OPEN Health Company, York, United Kingdom, and colleagues.

“Fixed-duration [venetoclax plus obinutuzumab] has the potential for cost savings compared with treat-to-progression chemotherapy-free regimens.

This analysis aimed to evaluate the cost-effectiveness of fixed-duration venetoclax plus obinutuzumab for 12 months compared to other first-line treatment regimens for unfit patients with CLL. Venetoclax plus obinutuzumab was compared to obinutuzumab plus chlorambucil, bendamustine plus rituximab, ibrutinib, ibrutinib plus obinutuzumab, ibrutinib plus rituximab, acalabrutinib, and acalabrutinib plus obinutuzumab.

Researchers developed a partitioned survival model with three health states: progression-free survival (PFS), postprogression survival, and dead. PFS and overall survival (OS) curves for venetoclax plus obinutuzumab and obinutuzumab plus chlorambucil, based on CLL14 trial data, were used to estimate the distribution of patients in each health state over time. PFS and OS for the additional comparators were estimated using hazard ratios vs venetoclax plus obinutuzumab, based on a network metaanalysis.

The model estimated life-years gained, quality-adjusted life-years (QALYs) gained, and costs over a time horizon of 20 years, with a cycle time of 28 days. Outcomes and costs were discounted at 3% per year. Costs were estimated from a US health care payer perspective. One-way and probabilistic sensitivity analyses were conducted.

In the base case, venetoclax plus obinutuzumab had lower projected total costs than all comparators. In addition, venetoclax plus obinutuzumab had larger projected health benefits than obinutuzumab plus chlorambucil, bendamustine plus rituximab, ibrutinib, and ibrutinib plus rituximab. 

Ibrutinib plus obinutuzumab, acalabrutinib, and acalabrutinib plus obinutuzumab demonstrated higher QALYs gained compared to venetoclax plus obinutuzumab (.022, .672, and .961, respectively). In additional, they demonstrated substantially higher projected costs compared to venetoclax plus obinutuzumab ($1,488,400, $1,579,737, and $1,656,154, respectively). 

At a willingness-to-pay threshold of $150,000 per QALY gained, ibrutinib plus obinutuzumab, acalabrutinib, and acalabrutinib plus obinutuzumab were not considered cost-effective compared with venetoclax plus obinutuzumab.

“Fixed-duration [venetoclax plus obinutuzumab] for 12 months is a cost-effective first-line treatment option for unfit CLL patients compared with other available options and provides value for money to US health care payers at a threshold of $150,000 per QALY gained,” concluded Dr Chatterjee and colleagues.