PSY45 - ECONOMIC EVALUATION OF IBRUTINIB FOR THE TREATMENT OF PATIENTS WITH RELAPSED OR REFRACTORY MANTLE-CELL LYMPHOMA IN MEXICO

Abstract

Mantle-cell lymphoma (MCL) is an incurable B-cell malignancies that overall has a poor prognosis with a median overall survival of 3-5 years. The choice of treatment for patients with relapsed or refractory disease patient becomes very complicated in terms of maximizing the highest efficacy with the best possible safety profile. Ibrutinib is administered orally at a dose of 560 mg once a day unlike I.V. treatment alternatives and is recommended in the most recent version of NCCN and ESMO clinical practice guidelines for patients with relapsed or refractory MCL. Evaluate ibrutinib as treatment for patients with relapsed or refractory MCL compared to available targeted therapies treatments in Mexico (bortezomib). A complete economic evaluation was performed through a cost minimization analysis. An indirect comparison between ibrutinib and bortezomib was developed to analyze differences in reported clinical outcomes and validated with statiscal analysis. The costs were obtained from institutional sources and resource use was validated trough a Deplhi panel. An exchange rate of $17 MXN per USD was applied. Sensitivity analyses were performed in order to test the robustness of the model and base case results. Additionally a budget impact model (BIM) was developed. Ibrutinib shows a net savings of 5%, equivalent to $3,115 USD compared to the cost associated with bortezomib. These net savings can be up to 30% ($24,884) if the cost of the bortezomib includes potential drug waste generated by excess drug in each vial. Robustness of results were confirmed by additional deterministic and probabilistic sensitivity analysis. The use of ibrutinib for the treatment of patients with relapsed or refractory mantle-cell lymphoma is a cost-saving alternative compared to bortezomib. Based on patient estimation the BIM proves the potential savings in institutional budget with the use of ibutinib in Mexican health care.