PCN158 - THE ADDED VALUE OF PERSONALIZED FOLLOW-UP FOR CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS

Abstract

Chronic lymphocytic leukemia (CLL) is a heterogeneous disease for which many patients (60%) never need treatment and a watchful waiting (WW) strategy is adopted. However, what WW should consist of is not standardized resulting in country differences. Personalizing follow-up for patients might be done using Next Generation Sequencing (NGS). Since using NGS data can be costly, we assessed the potential cost-effectiveness of applying them in CLL to personalize WW in Greece, Italy and Sweden. We first assessed current care by means of interviews with clinicians. Hereafter, we use a four state (WW, 1st line, 2nd line, death) Markov model with a lifetime horizon and a healthcare payer perspective to assess the potential cost-effectiveness of the analytics. We used retrospective data from three centers in Greece, Italy and Sweden and performed univariate, multivariate and probabilistic sensitivity analyses. Follow-up of patients in Italy and Greece is much more frequent than in Sweden resulting in higher costs of current care. We found improved stratification could potentially reduce costs in Greece and Italy (-€562, -€284) and increase costs in Sweden (€1062). Moreover, it may increase quality-adjusted life-years (QALYs) in all three countries (0.25, 0.17, 0.14) but the quality of life of WW patients is a much debated topic in the literature. Important influencers for all three countries were the quality of life of WW patients, costs of NGS and frequency of follow-up in current care. The heterogeneous nature of CLL often makes data aggregation across countries a requirement in CLL research. However, the large country differences in CLL should be considered as these greatly influence the relevance and the cost-effectiveness of NGS data analyses. Hence, it could be worthwhile to invest in NGS analytics, data collection and research in some countries but less so in others.