Economic evaluation of therapeutic sequences in the treatment of patients with chronic lymphocytic leukemia and coexisting conditions

• Main Authors: Antonio Cuneo, Roberto Ravasio, Nicola Amedeo Mazzanti
• Format: Article
• Language: English
• Published: AboutScience Srl 2017-10-01
• Series: Global & Regional Health Technology Assessment
• Online Access: http://www.grhta.com/Attach/4CE13B00-70A3-4C9D-8F0E-D0C428CA101C/AC83DE47-A154-459A-8E84-8A935CA25491

Economic evaluation of therapeutic sequences in the treatment of patients with chronic lymphocytic leukemia and coexisting conditionsIntroductionChronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative syndrome and it is the most common hematological malignancy in Western countries. It has a tendency to develop subsequent relapses, so affected patients are likely to undergo more than one line of treatment.MethodsRather than evaluating the cost-effectiveness of individual therapeutic agents, it becomes therefore recommendable for decision-makers to identify an optimal sequencing of such agents. A four-year cost-consequence analysis was conducted, comparing three alternative strategies for the first-line treatment of patients with previously untreated CLL and coexisting conditions: i) obinutuzumab with chlorambucil (Obi-Clb), ii) rituximab with chlorambucil (Rtx-Clb), and iii) ofatumumab with chlorambucil (Ofa-Clb). Only drug costs were considered in the analysis.ResultsIn two trials, median time to next treatment (TTNT) was longer in Obi-Clb (51.1 months) as compared to Rtx-Clb (38.2 months) or to Ofa-Clb (39.8 months). Therefore, during a 48-month time horizon, patients treated with Obi-Clb would maintain on average the first line treatment; on the contrary, patients treated with Rtx-Clb or with Ofa-Clb would receive on average a second line treatment consisting in the majority of cases of ibrutinib monotherapy, or rituximab with idelalisib or rituximab with bendamustine. The sequence using Obi-Clb regimen in first line showed the lower mean cost of treatment: €22,958 over the 48-month time horizon. Sensitivity analyses on a couple of scenarios provided similar conclusions in terms of overall costs.ConclusionObi-Clb as first-line treatment appears a recommendable strategy in terms of drug costs in the treatment of patients with previously untreated CLL and coexisting conditions.