Budget Impact Analysis of Fixed-Duration Ibrutinib+Venetoclax As Frontline Treatment of Chronic Lymphocytic Leukemia in the Brazilian Private Healthcare System

OBJECTIVES: Ibrutinib+venetoclax (I+V) is a new fixed-duration combination, 100% oral, for the treatment of chronic lymphocytic leukemia (CLL). The goal of this study is to estimate the budget impact of I+V as frontline treatment for CLL patients in the perspective of the Brazilian private healthcare system.

METHODS: A budget impact analysis (BIA) was developed to evaluate the financial impact from 2024 to 2028. Eligible population was estimated using official number of health plan users and available local and international epidemiology data. The BIA compared the current treatment scenario, in which patients use target-therapy-based regimens (ibrutinib monotherapy, acalabrutinib monotherapy and venetoclax+obinutuzumab), and a projected scenario with the inclusion of I+V. Only drug acquisition and administration costs were included, obtained from official Brazilian drug price list (CMED) and D-TISS, respectively. Treatment costs were estimated according to on-label recommendations. Market share estimates were obtained from IQVIA database, and I+V projection was assumed to reach 35% in 5 years.

RESULTS: New eligible patients varied from 523 in 2024 to 555 in 2028. The analysis estimated that the incremental BI varied from BRL 29.0 million in 2024 to –BRL 91.6 million in 2028, accounting for cumulative savings of BRL 56.4 million in 5 years. Sub-analysis by HMO size (large: 500,000 users; medium: 100,000 users; small: 20,000 users) resulted in cumulative savings of BRL 584.6 thousand, BRL 116.9 thousand and BRL 23.4 thousand, respectively.

CONCLUSIONS: This study shows that incorporation and increasing use of I+V may result in relevant budget savings to HMOs in the Brazilian private healthcare system, in addition to its clinical benefits to CLL patients as shown in previous clinical studies.