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Study Estimates the Total Lifetime Cost of Treating Patients With CLL in the US
Farrukh Awan, MD, University of Texas Southwestern Medical Center, Dallas, Texas, and colleagues recently estimated the total lifetime cost of treating patients with chronic lymphocytic leukemia (CLL) in the US. The study’s results were presented at the 2023 ASH Annual Meeting & Exposition.
The researchers developed a semi-Markov model with a lifetime horizon to estimate the per-patient cost of treating CLL for the total expected lifetime cost and total expected lifespan. All costs were discounted 3% per year and adjusted to 2023 US dollars.
The model consisted of the following health states: treatment by line of therapy (LOT), including first-line (1L) through fifth-line and later (5L+), and death. The authors selected the most commonly used treatments based on market share data and National Comprehensive Cancer Network–recommended guidelines; these included ibrutinib ± anti-CD20 monoclonal antibody (mAb), acalabrutinib ± anti-CD20 mAb, venetoclax-based regimens, chemoimmunotherapy, and phosphatidylinositol 3-kinase inhibitor–based regimens.
Patients entered the model during their first line of treatment, at which the cohort was assumed to be 70 years old and consisted of 64% male patients, based on median age and sex distribution reported in a study by Mato et al. The model included costs associated with drug acquisition and administration of CLL treatments, inpatient stays, outpatient visits, emergency department (ED) visits, Richter’s transformation, end-of-life care, and other health care resource utilization. Dr Awan and colleagues also conducted a scenario analysis to calculate the per-patient-per-year (PPPY) cost of each LOT and a one-way sensitivity analysis to identify key drivers of the total lifetime cost.
The results showed that the total expected lifetime cost of treating a patient with CLL in the US was estimated to be $1 142 357. Patients spent an estimated total of 8.03 years in the study’s model, with the majority time spent in 1L and 2L treatment stages (6 and 1.68 years, respectively). The probability of receiving 2L therapy was the highest at 44%, followed by 3L, 4L, and 5L+ at 16%, 6%, and 4%, respectively.
In the scenario analysis, the annual cost of treatment depended on the LOT, which ranged from $140 867 to $234 807 PPPY. The costs increased with each subsequent LOT. In addition, per the sensitivity analysis, drug acquisition costs were found to be the largest driver of the total lifetime cost of CLL treatment at 77%. ED and inpatient costs were the second largest driver at 20%, followed by other key drivers, which included hospitalization costs and patient starting age.
The researchers concluded that the expected lifetime cost of treating a patient with CLL in the US is high, with the cost increasing with each LOT. In addition, the cost of drugs (particularly Bruton tyrosine kinase inhibitors), was the top driver of total lifetime cost for this disease. Dr Awan and colleagues emphasized a need for potentially more effective one-time-only treatment options for patients with CLL.
Source: Awan FT, Vidisheva A, Saeedian M, Kurt M, Tiwana SK, Priyadarshini M. The Total Lifetime Cost of Treating Patients (Pts) with CLL in the United States (US). Presented at: 2023 ASH Annual Meeting & Exposition; December 9-12, 2023; San Diego, CA, and virtual; Abstract 2330.
