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

Una Valutazione Economica Delle Sequenze Terapeutiche nel Trattamento di Prima Linea Della Leucemia Linfatica Cronica in Pazienti Unfit non Pretrattati

  • Antonio Cuneo Sezione di Ematologia, Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara - Italy
  • Roberto Ravasio Health Publishing & Services Srl, Milano - Italy
  • Nicola Amedeo Mazzanti Roche S.p.A, Monza - Italy
Keywords: Chronic lymphocytic leukemia, Cost, Economic, Therapeutic sequences, Obinutuzumab, Time to next treatment

Abstract

Introduction Chronic 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. Methods Rather 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. Results In 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. Conclusion Obi-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.
Published
2017-10-23
How to Cite
CuneoA., RavasioR., & MazzantiN. A. (2017). Economic evaluation of therapeutic sequences in the treatment of patients with chronic lymphocytic leukemia and coexisting conditions. Global & Regional Health Technology Assessment, 4(1), 227-234. https://doi.org/10.33393/grhta.2017.399
Section
Original Research Article

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