Presentation (CTI)

OBJECTIVES: Compare the cost per month of progression free survival (PFS) of therapeutic treatment sequencing considering the treatments with local regulatory label approval for refractory/ relapsed mantle cell lymphoma (R/R MCL) in the Brazilian health system.
METHODS: The therapies considered in this analysis were the treatments with regulatory label approval for R/R MCL in Brazil: ibrutinib plus venetoclax (I+V), ibrutinib, acalabrutinib, zanubrutinib all have regulatory approval for use as second line of treatment (LoT); Pirtobrutinib is approved for use as a third LoT. We compared the PFS and costs of I+V with the PFS and costs of (a) ibrutinib followed by pirtobrutinib, (b) acalabrutinib followed by pirtobrutinib and (c) zanubrutinib followed by pirtobrutinib. The PFS data was retrieved from the follow-up studies of the therapies assessed. Only drug acquisition costs were considered (according to regulatory approved drug label dosage). Drug costs were retrieved from the Brazilian official drug price list (2025). The cost per month of PFS was calculated by dividing the total treatment cost in the median PFS period by the median PFS, in months.
RESULTS: I+V showed longer PFS results compared with the PFS of ibrutinib, acalabrutinib or zanubrutinib followed by pirtobrutinib (31.9 vs. 29.5, 29.4 and 28.5 months, respectively). I+V showed lower cost per month of PFS compared with the cost per month of PFS of ibrutinib or zanubrutinib followed by pirtobrutinib ($16.2 thousand [k] vs $19.1k and $17.4k, respectively) - as for acalabrutinib followed by pirtobrutinib, I+V showed 5,7% higher cost per month of PFS ($16.2k vs $15.4k), but 8,5% higher PFS.
CONCLUSIONS: I+V demonstrated lower cost per month of PFS when compared to zanubrutinib followed by pirtobrutinib, or ibrutinib followed by pirtobrutinib.