Evaluation of Healthcare Resource Utilization and Cost Among First-Line Patients Receiving Ibrutinib Vs Acalabrutinib for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL): A Commercial Claims Database Analysis

OBJECTIVES: To compare healthcare resource utilization (HRU) and cost in CLL/SLL patients who received first-line (1L) single-agent ibrutinib or acalabrutinib.

METHODS: This retrospective cohort study included CLL/SLL patients from a US commercial claims database. The index date was the date of initiating single-agent ibrutinib or acalabrutinib as 1L between 21NOV2019 and 30SEP2022. The other key selection criteria were: (1) ≥6 months continuous enrollment before index; (2) no other malignancies before index; (3) no other CLL/SLL treatment before or within the first 28 days after index. CLL/SLL-related HRU and cost (based on the first diagnosis field in claims) during the follow-up period were reported per patient per month (PPPM) and compared after adjustment of baseline demographic and clinical characteristics using propensity score weighting.

RESULTS: A total of 537 and 355 patients were included in the ibrutinib and acalabrutinib cohorts, respectively. Their baseline characteristics were similar, with a mean age of 64 years, 66% males, and Quan Charlson Comorbidity Index of 2.7 for both cohorts. Compared to the acalabrutinib cohort, the ibrutinib cohort had significantly lower PPPM CLL/SLL-related physician office visits (0.57 vs. 0.76) and outpatient visits (0.80 vs. 1.07) during the entire follow-up period. The adjusted rate ratio (aRR) after propensity score weighting was 0.83 (P<0.05) and 0.82 (P<0.01), respectively. Similar findings were obtained during the 1L period, which was 0.62 vs.0.83, aRR=0.81 (P<0.01) for physician office visits, and 0.86 vs. 1.09, aRR=0.85 (p<0.05) for outpatient visit. The ibrutinib cohort also had significantly lower mean PPPM CLL/SLL-related total costs than acalabrutinib during the entire follow-up period, which was $13,657 vs. $15,864. The adjusted mean difference was $956, (p<0.05) after propensity score weighting.

CONCLUSIONS: Use of single-agent ibrutinib in 1L CLL/SLL was associated with fewer CLL/SLL related physician office visit, outpatient visit, and total cost than 1L acalabrutinib.