Healthcare Cost Comparison Between 1L Ibrutinib and Acalabrutinib in Chronic Lymphocytic Leukemia Patients in the Veterans Affairs Population
Author(s)
Lindsey Fitzgerald, MD1, Sabyasachi Ghosh, MS2, Alex Bokun, PharmD2, Angela Lax, MPH3, Fan Mu, PhD, MS3, Yilu Lin, PhD, MPH4, Lizheng Shi, PhD4, Zaina Qureshi, PhD, MS, MPH2, Solomon Graf, MD5;
1Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA, 2Janssen Scientific Affairs, a Johnson & Johnson Company, Horsham, PA, USA, 3Analysis Group, Inc., Boston, MA, USA, 4School of Public Health and Tropical Medicine, Tulane University, Department of Health Policy and Management, New Orleans, LA, USA, 5University of Washington School of Medicine, Department of Hematology/Oncology, Seattle, WA, USA
1Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA, 2Janssen Scientific Affairs, a Johnson & Johnson Company, Horsham, PA, USA, 3Analysis Group, Inc., Boston, MA, USA, 4School of Public Health and Tropical Medicine, Tulane University, Department of Health Policy and Management, New Orleans, LA, USA, 5University of Washington School of Medicine, Department of Hematology/Oncology, Seattle, WA, USA
OBJECTIVES: Ibrutinib and acalabrutinib are Bruton’s tyrosine kinase inhibitors (BTKis) recommended as first-line treatments for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). This study aimed to compare total cost of care during the initial 12 months of BTKi treatment in CLL/SLL patients receiving 1L monotherapy ibrutinib or acalabrutinib.
METHODS: This study identified Veterans Affairs (VA) patients with CLL/SLL who initiated 1L treatment with ibrutinib or acalabrutinib after 11/2019. BTKi initiation was the index date. Cohorts were formed based on 1L BTKi treatment (ibrutinib or acalabrutinib). Patient characteristics were evaluated during the 1-year pre-index baseline period. All-cause and CLL-related (defined as records with diagnosis for CLL/SLL) healthcare costs (2024 USD) were described and compared between cohorts during the 1-year post-index on-treatment period. Mean cost differences were estimated using generalized linear models with a Tweedie distribution. Adjusted models included covariates for key baseline characteristics (age, sex, comorbidity burden, healthcare resource use).
RESULTS: 732 ibrutinib and 327 acalabrutinib patients were included, with an average age of 72.5 and 74.3 years, respectively. Overall, most patients were male, white, and non-Hispanic. Total annual all-cause costs were $139,589 for ibrutinib and $142,749 for acalabrutinib. CLL-related costs were $117,301 and $121,069, respectively. During 1-year follow-up, after adjusting for baseline characteristics, mean all-cause and CLL-related costs were numerically lower for ibrutinib compared to acalabrutinib, though not significantly different (-$2,422, p=0.46 and -$3,804, p=0.14, respectively).
CONCLUSIONS: To our knowledge, this is the first study to evaluate costs of 1L BTKis among CLL/SLL patients in the VA. Costs during the first year of treatment were similar between patients initiating BTKis, with ibrutinib showing numerically lower total healthcare costs. While costs in the VA may be different than those outside the VA, these results can serve as a benchmark for future research on cost of care with BTKis following implementation of inflation reduction act policies.
METHODS: This study identified Veterans Affairs (VA) patients with CLL/SLL who initiated 1L treatment with ibrutinib or acalabrutinib after 11/2019. BTKi initiation was the index date. Cohorts were formed based on 1L BTKi treatment (ibrutinib or acalabrutinib). Patient characteristics were evaluated during the 1-year pre-index baseline period. All-cause and CLL-related (defined as records with diagnosis for CLL/SLL) healthcare costs (2024 USD) were described and compared between cohorts during the 1-year post-index on-treatment period. Mean cost differences were estimated using generalized linear models with a Tweedie distribution. Adjusted models included covariates for key baseline characteristics (age, sex, comorbidity burden, healthcare resource use).
RESULTS: 732 ibrutinib and 327 acalabrutinib patients were included, with an average age of 72.5 and 74.3 years, respectively. Overall, most patients were male, white, and non-Hispanic. Total annual all-cause costs were $139,589 for ibrutinib and $142,749 for acalabrutinib. CLL-related costs were $117,301 and $121,069, respectively. During 1-year follow-up, after adjusting for baseline characteristics, mean all-cause and CLL-related costs were numerically lower for ibrutinib compared to acalabrutinib, though not significantly different (-$2,422, p=0.46 and -$3,804, p=0.14, respectively).
CONCLUSIONS: To our knowledge, this is the first study to evaluate costs of 1L BTKis among CLL/SLL patients in the VA. Costs during the first year of treatment were similar between patients initiating BTKis, with ibrutinib showing numerically lower total healthcare costs. While costs in the VA may be different than those outside the VA, these results can serve as a benchmark for future research on cost of care with BTKis following implementation of inflation reduction act policies.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE421
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology