Presentation (CTI)

OBJECTIVES: Bruton tyrosine kinase inhibitors (BTKis) have revolutionised the first-line (1L) treatment of chronic lymphocytic leukaemia (CLL) and are well-established in clinical practice. Second-generation BTKis such as acalabrutinib are now available and offer reduced off-target effects compared to the first-generation BTKi, ibrutinib. This study assesses the cost of adverse events (AEs) with acalabrutinib versus ibrutinib in 1L treatment of CLL to determine the financial impact of these clinical differences in the Brazilian private healthcare context.
METHODS: The base case analysis considered grade ≥3 AEs and AEs of special interest, as reported in the acalabrutinib monotherapy arm of the ELEVATE-TN trial. For ibrutinib, AE rates were reported from the ibrutinib monotherapy arm of the RESONATE-2 and A041202 trials. Because RESONATE-2 only reported AEs occurring in at least 15% of patients, the scenario analysis considered the A041202 trial as the primary source of data for ibrutinib AE rates. All cost estimates were derived from available data in Brazil.
RESULTS: Assuming a cohort of 100 patients, the base case analysis showed that the cost of managing AEs with acalabrutinib in the base case was R$113,296 (€16,994) versus R$194,522 (€29,178) with ibrutinib, a reduction of 41.8% (R$81,225.63 [€12,184]) in favour of acalabrutinib. These savings were primarily driven by the costs of managing atrial fibrillation, thrombocytopaenia, and infections. In the scenario analysis, cost savings with acalabrutinib increased to R$197,926 (€29,689, R$113,296 [€16,994] vs R$311,222 [€46,683]) with higher rates of atrial fibrillation and hypertension for ibrutinib in the A041202 trial being the major drivers.
CONCLUSIONS: The improved safety profile of second- versus first-generation BTKis can result in savings in healthcare costs. AE costs should be considered as part of a holistic decision-making process for reimbursement/funding of 1L CLL treatments.