BUDGET IMPACT OF INTRODUCING PIRTOBRUTINIB AFTER COVALENT BRUTON TYROSINE KINASE INHIBITOR THERAPY IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA IN THE US
Author(s)
Timothy Klein, BS1, Katherine B. Winfree, MPH, MS, PhD2, Kari Kelton, PhD1, Catherine E Muehlenbein, MPH, MBA2, Andrea LeVoir, Pharm D2, Marsha L. Tracey, PhD2, Ehsan L. Masoudi, PhD2;
1Medical Decision Modeling Inc., Indianapolis, IN, USA, 2Eli Lilly and Company, Indianapolis, IN, USA
1Medical Decision Modeling Inc., Indianapolis, IN, USA, 2Eli Lilly and Company, Indianapolis, IN, USA
OBJECTIVES: Pirtobrutinib improved progression-free survival and demonstrated favorable tolerability versus investigator’s choice of idelalisib/rituximab or bendamustine/rituximab in covalent Bruton tyrosine kinase inhibitor (cBTKi) pretreated patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; BRUIN-CLL-321, NCT04666038). This analysis estimated the budget impact of introducing pirtobrutinib for post-cBTKi CLL/SLL in the US.
METHODS: Eligible patients were estimated using 2017 Surveillance, Epidemiology, and End Results Program incidence data; treatment pattern data derived from the US-based, nationwide Flatiron Health electronic health record-derived deidentified database. The model estimated budget impact from Medicare and commercial payer perspective following pirtobrutinib market introduction. Costs for drug acquisition, administration, monitoring, and treatment of adverse events were estimated using published sources, applying market shares for post-cBTKi therapy. Treatment duration of pirtobrutinib was based on the BRUIN-CLL-321 study. Annual incremental total and per-member-per-month (PMPM) costs were estimated over a 5-year period (2026-2030) per million members. One-way sensitivity analyses (OWSA) were conducted to test the robustness of the PMPM results.
RESULTS: Annually, an estimated 19.9 per million Medicare and 0.8 per million commercial patients were eligible for pirtobrutinib. From the Medicare perspective, the annual incremental budget impact following introduction of pirtobrutinib ranged from $234,291 in year one (2026) to $1,473,526 in year five (2030) per million members, with annual PMPM costs ranging $0.0195 to $0.1228. From the commercial perspective, the annual incremental budget impact ranged from $8,508 (2026) to $54,318 (2030), equivalent to annual PMPM costs ranging $0.0007 to $0.0045. Monthly pirtobrutinib acquisition cost and treatment duration were the most influential parameters per the OWSA for both perspectives.
CONCLUSIONS: The introduction of pirtobrutinib as post-cBTKi therapy for patients with CLL/SLL resulted in minimal annual PMPM costs for both Medicare and commercial payers. This finding reflects the low number of eligible patients and is highly influenced by monthly acquisition costs and duration of pirtobrutinib therapy.
METHODS: Eligible patients were estimated using 2017 Surveillance, Epidemiology, and End Results Program incidence data; treatment pattern data derived from the US-based, nationwide Flatiron Health electronic health record-derived deidentified database. The model estimated budget impact from Medicare and commercial payer perspective following pirtobrutinib market introduction. Costs for drug acquisition, administration, monitoring, and treatment of adverse events were estimated using published sources, applying market shares for post-cBTKi therapy. Treatment duration of pirtobrutinib was based on the BRUIN-CLL-321 study. Annual incremental total and per-member-per-month (PMPM) costs were estimated over a 5-year period (2026-2030) per million members. One-way sensitivity analyses (OWSA) were conducted to test the robustness of the PMPM results.
RESULTS: Annually, an estimated 19.9 per million Medicare and 0.8 per million commercial patients were eligible for pirtobrutinib. From the Medicare perspective, the annual incremental budget impact following introduction of pirtobrutinib ranged from $234,291 in year one (2026) to $1,473,526 in year five (2030) per million members, with annual PMPM costs ranging $0.0195 to $0.1228. From the commercial perspective, the annual incremental budget impact ranged from $8,508 (2026) to $54,318 (2030), equivalent to annual PMPM costs ranging $0.0007 to $0.0045. Monthly pirtobrutinib acquisition cost and treatment duration were the most influential parameters per the OWSA for both perspectives.
CONCLUSIONS: The introduction of pirtobrutinib as post-cBTKi therapy for patients with CLL/SLL resulted in minimal annual PMPM costs for both Medicare and commercial payers. This finding reflects the low number of eligible patients and is highly influenced by monthly acquisition costs and duration of pirtobrutinib therapy.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE149
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Oncology