Cost-Effectiveness Analysis of Acalabrutinib for Patients With Relapse and Refractory Chronic Lymphocytic Leukemia (R/R CLL)

OBJECTIVES: Chronic lymphocytic leukemia is a chronic lymphoproliferative disorder characterized by monoclonal B cell proliferation and is often associated with a poor prognosis. This study aimed to evaluate the cost-effectiveness of acalabrutinib compared to zanubrutinib in the treatment of relapse and refractory chronic lymphocytic leukemia (R/R CLL) from the perspective of the Chinese healthcare system.

METHODS: A three-state partitioned survival model was constructed to simulate the lifetime outcomes and costs for R/R CLL patients, with a 28-day cycle and a discount rate of 5% applied to both costs and health outcomes. Clinical parameters were derived from the ASCEND trial of acalabrutinib and the ALPINE trial of zanubrutinib. Utility values were obtained from ASCEND trial and published literature. Costs and medical resource utilization data were sourced from databases and clinical expert consultations. Incremental cost-effectiveness ratios (ICERs) were calculated based on the total costs and quality-adjusted life years (QALYs) for each treatment, with three times Chinese gross domestic product (GDP) used as the cost-effectiveness threshold. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the base analysis results.

RESULTS: Acalabrutinib achieved 8.33 QALYs at a total cost of Chinese Yuan (CNY) 757,227, while zanubrutinib achieved 6.93 QALYs at a total cost of CNY 655,863. Compared to zanubrutinib, acalabrutinib gained an additional 1.41 QALYs at an extra cost of CNY 101,364, resulting in an ICER of CNY 71,944 per QALY gained. Deterministic sensitivity analysis indicated that the ICER was most sensitive to the hazard ratio of progression-free survival. The probability of acalabrutinib being cost-effectiveness was 81.90% at a threshold of three times the per capita GDP.

CONCLUSIONS: Acalabrutinib was estimated to be a cost-effective option compared to zanubrutinib for the treatment of R/R CLL from the Chinese healthcare perspective.