BUDGET IMPACT ANALYSIS OF IMPROVED SAFETY AND EFFICACY WITH ACALABRUTINIB, BENDAMUSTINE, AND RITUXIMAB IN TRANSPLANT-INELIGIBLE, PREVIOUSLY UNTREATED MCL
Author(s)
Jia Ruan, MD, PhD1, Hsin-Yun Yang, PhD2, Essam Ibrahim, MD3, Catherine Lowthorpe, MPH2, Victor Genestier, MSc2, Anna Teschemaker, PhD3;
1Weill Cornell Medicine, Lymphoma Program, Division of Hematology & Medical Oncology, New York, NY, USA, 2Amaris Consulting, Toronto, ON, Canada, 3AstraZeneca, Gaithersburg, MD, USA
1Weill Cornell Medicine, Lymphoma Program, Division of Hematology & Medical Oncology, New York, NY, USA, 2Amaris Consulting, Toronto, ON, Canada, 3AstraZeneca, Gaithersburg, MD, USA
OBJECTIVES: The recently approved acalabrutinib (A) plus bendamustine and rituximab (BR) combination demonstrated improved progression-free survival (PFS) versus BR in pts with previously untreated, HSCT-ineligible, mantle cell lymphoma (MCL). However, its financial impact remains uncertain, to address this, a budget impact model (BIM) was developed.
METHODS: The BIM assessed a world with and a world without ABR from a US Medicare payer perspective applied over a 3-yr time horizon (2025-2027). The analysis compared ABR to standard of care (SoC) first-line (1L) MCL regimens. ABR was assumed to capture 8% of the 1L market in Yr1, rising to 43% in Yr3, with corresponding declines in comparators. Epidemiology, clinical, and cost inputs were derived from US-specific data and sources.
RESULTS: Medicare costs were reduced by ABR, with cumulative budget impacts of -$278,737 (Yr1), -$190,308 (Yr2), and $841,629 (Yr3). The largest savings stemmed from ABR improving PFS, which reduced subsequent drug acquisition by $371,566 (Yr1) and $391,930 (Yr2), this offset the higher Yr3 1L acquisition costs. Improved survival (HR: 0.86; 95% CI: 0.65-1.13; P=0.27) saw more patients remaining progression-free and continuing treatment into Yr3. Additional savings included acalabrutinib's no-cost oral administration and lower AE rates. Without ABR, cumulative costs per member per month (PMPM) rose from $0.09 (Yr1) to $0.30 (Yr2), and $0.56 (Yr3). With ABR, they rose from $0.07 (Yr1) to $0.29 (Yr2), and $0.63 (Yr3). The incremental budget impact PMPM benchmarked against the scenario without ABR, corresponded to -25.6% (Yr1), 3.46% (Yr2), and 33.1% (Yr3).
CONCLUSIONS: Significant savings in Yrs 1 and 2 resulted from a reduced need for subsequent therapies. Increased Yr3 costs reflected improved survival outcomes and prolonged ABR treatment duration. Together with clinical evidence, these findings can help inform optimal 1L treatment options for clinicians and payers.
METHODS: The BIM assessed a world with and a world without ABR from a US Medicare payer perspective applied over a 3-yr time horizon (2025-2027). The analysis compared ABR to standard of care (SoC) first-line (1L) MCL regimens. ABR was assumed to capture 8% of the 1L market in Yr1, rising to 43% in Yr3, with corresponding declines in comparators. Epidemiology, clinical, and cost inputs were derived from US-specific data and sources.
RESULTS: Medicare costs were reduced by ABR, with cumulative budget impacts of -$278,737 (Yr1), -$190,308 (Yr2), and $841,629 (Yr3). The largest savings stemmed from ABR improving PFS, which reduced subsequent drug acquisition by $371,566 (Yr1) and $391,930 (Yr2), this offset the higher Yr3 1L acquisition costs. Improved survival (HR: 0.86; 95% CI: 0.65-1.13; P=0.27) saw more patients remaining progression-free and continuing treatment into Yr3. Additional savings included acalabrutinib's no-cost oral administration and lower AE rates. Without ABR, cumulative costs per member per month (PMPM) rose from $0.09 (Yr1) to $0.30 (Yr2), and $0.56 (Yr3). With ABR, they rose from $0.07 (Yr1) to $0.29 (Yr2), and $0.63 (Yr3). The incremental budget impact PMPM benchmarked against the scenario without ABR, corresponded to -25.6% (Yr1), 3.46% (Yr2), and 33.1% (Yr3).
CONCLUSIONS: Significant savings in Yrs 1 and 2 resulted from a reduced need for subsequent therapies. Increased Yr3 costs reflected improved survival outcomes and prolonged ABR treatment duration. Together with clinical evidence, these findings can help inform optimal 1L treatment options for clinicians and payers.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE140
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Oncology