Estimated Total Cost of Care (TCC) of First-Line (1L) Fixed-Duration BCL2i versus Treat-To-Progression BTKi Regimens in Patients with Chronic Lymphocytic Leukemia (CLL) in the United States (US): A Population-Based Model

OBJECTIVES: To estimate the annual TCC burden in the US for treating 1L CLL with fixed-duration treatment (FDT) B-cell lymphoma 2 inhibitor (BCL2i) versus treat-to-progression (TTP) Bruton’s tyrosine kinase inhibitor (BTKi) regimens.
METHODS: A US population model was developed to calculate the TCC for 1L CLL over 10 years (2019-2028), comparing an all-BCL2i-treated versus an all-BTKi-treated population. Patient cohorts were entered annually and were followed for 3 and 5 years. CLL incidence rates were sourced from the Surveillance, Epidemiology and End Results Program, and applied to the US population. Per-patient yearly costs by treatment were derived from a published TCC model. The FDT BCL2i regimen included venetoclax-obinutuzumab, with duration assumed to be 1 year; TTP BTKi regimens included ibrutinib, ibrutinib-rituximab, ibrutinib-obinutuzumab, acalabrutinib, and acalabrutinib-obinutuzumab. TCC incorporated treatment (i.e., drug, administration), adverse event management, routine care, and monitoring costs from published sources. Dosing and safety data were obtained from clinical trials and US package inserts. Drug costs used average wholesale acquisition costs from Truven Health Analytics Red Book® (2019-2024); post-2024 prices were projected based on historic price trends.
RESULTS: In 2019, the estimated management cost of 1L CLL in the US was $1.93 billion (B) and $1.94B for hypothetical all-BCL2i-treated and all-BTKi-treated populations, respectively. By 2028, the estimated cost for an all-BCL2i-treated and all-BTKi-treated population was $3.92B versus $7.00B with a 3-year follow-up, and $4.64B versus $11.45B with a 5-year follow-up, respectively. Over 10 years, an all-BTKi-treated population would incur an additional $25.4B versus an all-BCL2i-treated population with a 3-year follow-up, and an additional $48.1B with a 5-year follow-up, primarily due to continued drug costs.
CONCLUSIONS: Over 10 years, a hypothetical all-BCL2i-treated 1L CLL population could save the US up to $48.1B versus an all-BTKi-treated 1L CLL population. Despite rising overall CLL costs, FDT regimens resulted in substantial cost savings versus TTP regimens.