Abstract
In 2016 the incidence of CLL was 3,9 new cases and the mortality was 0,9 deaths per 100.000 American. Future projections indicate an increase in those. In Colombia data about CLL is scarce. To estimate the cost-effectiveness of Venetoclax+Rituximab (VEN+R) versus ibrutinib in the treatment of Relapsed/Refractory (R/R) Chronic Lymphocytic Leukaemia (CLL), from the Colombian Healthcare System perspective. We adapt the original cost-effectiveness model of VEN+R for United Kingdom population. Three-state partitioned survival model includes health states for progression free, progressed and dead in the time horizon of 30 years. Costs and health benefits are discounted by 5% per annum. Venetoclax is first delivered according to a dose ramping schedule and Rituximab is delivered after completion of the dose ramp up period. The key measure of health benefit is the Quality-Adjusted Life Year (QALY) and life year (LY). The cost included the treatment, management and monitoring of CLL at Colombian prices of 2018. The willingness to pay of 3 times gross domestic product (GDP) per capita. Costs and QALYs are presented for each comparator, incremental costs, incremental QALYs and ICERs are also presented. Deterministic and probabilistic sensitivity analysis were performed. The cost, LYGs, and QALYs of VEN+R were COP 496.339.802, 6,34 and 4,45, respectively. VEN+R was less costly (savings: 299.025.132) and more efficacious than ibrutinib in terms of LYGs and QALYs, showing incremental effectiveness of 2,25 and 1,42 respectively. These results show that VEN+R is a dominant treatment strategy over ibrutinib in relapsed/refractory Chronic Lymphocytic Leukemia in Colombia. Base case results are maintained among the simulated scenarios for the sensitivity analysis. The results of this study suggest that in Colombian context, 24-month fixed duration treatment with VEN+R would be a cost effectiveness alternative in R/R CLL patients due to its dominance (more efficacious and less expensive) over ibrutinib.
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