The Economic Impact of Treatment Sequences for Chronic Lymphocytic Leukemia in the United States: A Cost of Care and Budget Impact Model of Venetoclax Plus Obinutuzumab Sequences

Abstract

We estimated the total cumulative costs per patient of treatment sequences for adults with chronic lymphocytic leukemia (CLL), with and without deletion 17p, as well as the budget impact of introducing sequences with first-line (1L) venetoclax + obinutuzumab (V+O) from a US payer perspective. Efficacy, treatment-related costs, and epidemiological inputs were informed by clinical trial publications and public data sources. Cumulative costs per patient (2020 US $) were estimated over 10 years. The results indicated that among adults with CLL with deletion 17p, the 10-year cumulative costs of sequences starting with fixed-duration V+O were lower ($935,781-$1,345,96) than those starting with ibrutinib or acalabrutinib ($1,426,924-$1,906,544); similar results were estimated in adults without deletion 17p (V+O: $690,346- $951,633; ibrutinib or acalabrutinib: $1,720,745-$1,976,767). Retreatment with a venetoclax-based regimen after 1L also resulted in treatment sequences with low costs. In a hypothetical 1-million-member health plan, the total budget impact of introducing sequences with 1L fixed-duration V+O led to cost savings of $12.5 and $56.4 million over 5 and 10 years, respectively.