Session: 902. Health Services and Quality Improvement: Lymphoid Malignancies: Poster III
Hematology Disease Topics & Pathways:
Lymphoid Leukemias, CLL, Diseases, Lymphoid Malignancies, Adverse Events
METHODS: An economic model was constructed to simulate health and economic outcomes among patients with both TN and RR patients with CLL treated with cBTKi. A Markov model approach simulated transitions between 4 treatment pathway health states: cBTKi, venetoclax + rituximab, subsequent treatment (pooled pirtobrutinib, CAR T, and best supportive care), and death. Cumulative grade ≥3 adverse event (AE) rates for cBTKis were obtained from extended follow-up data of phase III RCTs to ensure similar follow-up duration. Treatments were dosed according to FDA labels and efficacy was assumed to be identical across cBTKi. Drug prices were based on 2024 wholesale acquisition costs (WACs). Medical costs associated with treatment of AEs used Medicare reimbursement rates. Outcomes were total change in cost from cBTKis treatment choice over a 1-year time period. Subgroup analysis examined outcomes for CLL patients in CMS special subpopulations (disabled, end-stage renal disease (ESRD), terminally ill). Sensitivity analyses included using MAIC results to inform AE rates and examining 3 and 5-year time horizons.
RESULTS: A cohort of 18,474 CLL patients was modeled (74% TN, 26% RR) to reflect real-world prevalence in Medicare. Annual WACs for acalabrutinib, ibrutinib, and zanubrutinib were $186,979, $213,677, and $183,303, respectively. Acalabrutinib showed cost savings of $16,919 per Medicare patient ($313 million across all Medicare patients with CLL) vs. ibrutinib over 1 year since treatment initiation, driven by lower treatment cost ($12,224 decrease) and lower AE cost ($4,695 decrease). Differences in AE costs were driven by differences in unadjusted rates of grade ≥3 atrial fibrillation (1.1% acalabrutinib vs. 5.2% ibrutinib), hypertension (2.8% vs. 8.1%), and infections (16.2% vs. 20.6%) in TN, and hypertension (4% vs. 9%), diarrhea (1% vs. 5%) and neutropenia (20% vs. 23%) in RR. Compared to zanubrutinib, acalabrutinib showed cost savings of $2,529 per patient ($47 million across all Medicare patients with CLL). Higher acalabrutinib treatment cost vs. zanubrutinib ($1,683 increase) was offset by savings from lower AE cost ($4,212 decrease). Differences in AE costs were driven by differences in hypertension and infections in TN (2.8% acalabrutinib vs. 9.2% zanubrutinib; 16.2% vs. 23.8%) and hypertension and infections in RR (4.0% vs. 16.4%; 31.0% vs. 35.5%). Sensitivity analysis using MAIC AE rates similarly showed overall cost savings per patient vs. ibrutinib ($16,209 decrease) and vs. zanubrutinib ($300 decrease) over 1 year. Acalabrutinib treatment of disabled, ESRD, and terminally ill Medicare CLL patients was associated with reduced grade ≥3 AEs vs. ibrutinib (2,640, 180, and 527 fewer, respectively) and vs. zanubrutinib (2,120, 152, and 451 fewer). Acalabrutinib showed cost savings of $187 million, $13 million, and $42 million vs. ibrutinib, and $31 million, $2.1 million, and $6.3 million vs. zanubrutinib across disabled, ESRD, and terminally ill, respectively. Overall cost savings per CLL patient vs. ibrutinib and zanubrutinib were maintained over 3 ($25,615; $1,331) and 5 ($27,635; $1,053) year horizons.
CONCLUSIONS: Acalabrutinib yielded cost savings compared to ibrutinib and zanubrutinib for Medicare patients with CLL due to lower treatment cost (ibrutinib) and fewer AEs (both ibrutinib and zanubrutinib). Findings were consistent across sub-groups and sensitivity analyses.
Disclosures: Kittai: Galapagos: Consultancy; BMS: Consultancy; AstraZeneca: Consultancy, Research Funding, Speakers Bureau; BeiGene: Consultancy, Research Funding, Speakers Bureau; Eli-Lilly: Consultancy; Abbvie: Consultancy. Patel: AstraZeneca: Current Employment. Shafrin: FTI Consulting: Consultancy, Current Employment. Zawadzki: FTI Consulting: Current Employment. Shetty: AstraZeneca: Current Employment, Current equity holder in private company, Current holder of stock options in a privately-held company. Sharma: FTI Consulting, LLC: Current Employment; AstraZeneca: Research Funding. Barqawi: AstraZeneca, PLC: Current Employment, Current equity holder in publicly-traded company, Divested equity in a private or publicly-traded company in the past 24 months, Research Funding; AbbVie, Inc.: Ended employment in the past 24 months; UCB Inc.: Consultancy. Rhodes: Oncternal Therapeutics: Research Funding; Loxo Oncology: Research Funding; Janssen: Research Funding; Acerta: Research Funding; Verastem: Consultancy; TG Therapeutics: Consultancy; Seagen: Consultancy; Pharmacyclics: Consultancy, Research Funding; MorphoSys: Consultancy; Johnson and Johnson: Consultancy; Genentech: Consultancy; Epizyme: Consultancy; Beigene: Consultancy; ADC Therapeutics: Consultancy; AbbVie: Consultancy, Research Funding; VelosBio: Research Funding.
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