Cost-Effectiveness Analysis for Acalabrutinib in the Treatment of Patients With Relapsed/Refractory Mantle Cell Lymphoma (r/r MCL) in China

OBJECTIVES: MCL is a rare and aggressive subtype of non-Hodgkin lymphoma (NHL), accounting for 3.5% of all incident NHL cases in China. Acalabrutinib and ibrutinib are BTK inhibitors used in patients with relapsed/refractory mantle cell lymphoma (r/r MCL) who have undergone prior therapy.This study aims to conduct an economic evaluation of acalabrutinib compared to ibrutinib for r/r MCL patients within the Chinese healthcare system.

METHODS: A partitioned survival model was employed, which consisted of three health states of progression-free survival (PFS), post-progression (PD), and death. The proportion of patients in each state was determined based on parametric distributions fitted to survival data from PCYC-1104 trial for ibrutinib and extrapolated modeling weighted by Hazard Ratio (HR) , which gained from the matching-adjusted indirect comparisons of acalabrutinib versus ibrutinib. The analysis only considered direct medical costs, including drug acquisition, subsequent treatments, disease management, adverse event management, and end-of-life therapies. Both health costs and outcomes were discounted at a rate of 5%. Utility values for health states and adverse events were obtained from relevant literature. Quality-adjusted life years (QALYs) gained were calculated for each intervention over a time horizon of 20 years. Incremental costs per QALY gained were estimated to compare acalabrutinib with the comparator. Deterministic and probabilistic analyses were conducted.

RESULTS: Over a time horizon of 20 years, the use of acalabrutinib generates a total cost of ¥406,587 per patient versus ¥504,811 per patient generated with ibrutinib. The effectiveness analysis shows that treatment with acalabrutinib is associated with an incremental gain of 0.78 QALYs (3.70 versus 2.92). When comparing the savings between acalabrutinib and ibrutinib, a dominant result is obtained.

CONCLUSIONS: Given a willingness-to-pay (WTP) threshold of 2 times the Gross Domestic Product per capita (CNY171,396,2022) in China, acalabrutinib compared to ibrutinib is a dominant alternative in the treatment of patients with r/r MCL.