Costs and Consequences of Cardiovascular Toxicity Due to Bruton's Tyrosine Kinase Inhibitors in Chronic Lymphocytic Leukemia
Author(s)
Débora Figueira, MSc1, João Costa, PhD1, Manuela Fiuza, MD2, Andreia Magalhães, MD2, Mariana Paiva, MD3, Mariana Saraiva, MD4, Pedro Gonçalves-Teixeira, MD5, Margarida Borges, MD6.
1IQVIA, Porto Salvo - Oeiras, Portugal, 2Unidade Local de Saúde de Santa Maria, Lisboa, Portugal, Lisboa, Portugal, 3Unidade Local de Saúde de São João, Porto, Portugal, Porto, Portugal, 4Unidade Local de Saúde da Região de Leiria, Leiria, Leiria, Portugal, 5Unidade Local de Saúde de Gaia e Espinho, Vila Nova de Gaia, Portugal, Vila Nova de Gaia, Portugal, 6Principal, IQVIA, Porto Salvo - Oeiras, Portugal.
1IQVIA, Porto Salvo - Oeiras, Portugal, 2Unidade Local de Saúde de Santa Maria, Lisboa, Portugal, Lisboa, Portugal, 3Unidade Local de Saúde de São João, Porto, Portugal, Porto, Portugal, 4Unidade Local de Saúde da Região de Leiria, Leiria, Leiria, Portugal, 5Unidade Local de Saúde de Gaia e Espinho, Vila Nova de Gaia, Portugal, Vila Nova de Gaia, Portugal, 6Principal, IQVIA, Porto Salvo - Oeiras, Portugal.
OBJECTIVES: BTK inhibitors (BTKis) have revolutionized the treatment landscape of chronic lymphocytic leukemia (CLL). However, a higher risk of cardiovascular toxicity is reported among CLL patients treated with BTKis. This study aimed to estimate the costs and consequences of cardiovascular toxicity associated with the different BTKis used for CLL treatment in Portugal.
METHODS: The incidence rates and health-related outcomes consequences among CLL patients namely bleeding events, de novo atrial fibrillation (AF) and hypertension were retrieved from the literature for the different BTKis. Direct medical costs (payers' perspective) associated with diagnosis, monitoring and treatment of cardiovascular toxicity were calculated for one year. Inpatient costs were derived from the Portuguese Hospital Morbidity Database and valued at the prices defined by Ordinance No. 207/2007, in its last version. Outpatient costs were estimated from an expert panel composed by five physicians specialized in CLL patients care.
RESULTS: Incidence rates per 100 CLL BTKis-treated patients were 38.0 (acalabrutinib), 51.3 (ibrutinib) and 70.3 (zanubrutinib) for bleeding, 5.4 (zanubrutinib), 6.2 (acalabrutinib) and 14.9 (ibrutinib) for AF, and 6.6 (acalabrutinib), 22.8 (ibrutinib) and 36.7 (zanubrutinib) for hypertension. Incidence rates of health outcomes related to AF (stroke and heart failure) were higher among ibrutinib-treated patients, whereas health outcomes related to hypertension (angina, myocardial infarction, heart failure and peripheral arterial disease) were higher among zanubrutinib-treated patients. Total direct medical costs per 100 CLL patients treated with BTKis over the first year were €38,803.10, €82,683.61, and €86,084.56 for acalabrutinib, zanubrutinib, and ibrutinib, respectively. In subsequent years, costs decreased to €20,429.78, €46,778.58, and €52,693.13 for acalabrutinib, zanubrutinib, and ibrutinib, respectively, which corresponds to a decrease of 39 to 47%.
CONCLUSIONS: The clinical and economic burden of cardiovascular toxicity from BTKis treatment in CLL patients is notable. Ibrutinib is associated with the highest costs and more frequent health consequences, while acalabrutinib revealed a lower overall impact.
METHODS: The incidence rates and health-related outcomes consequences among CLL patients namely bleeding events, de novo atrial fibrillation (AF) and hypertension were retrieved from the literature for the different BTKis. Direct medical costs (payers' perspective) associated with diagnosis, monitoring and treatment of cardiovascular toxicity were calculated for one year. Inpatient costs were derived from the Portuguese Hospital Morbidity Database and valued at the prices defined by Ordinance No. 207/2007, in its last version. Outpatient costs were estimated from an expert panel composed by five physicians specialized in CLL patients care.
RESULTS: Incidence rates per 100 CLL BTKis-treated patients were 38.0 (acalabrutinib), 51.3 (ibrutinib) and 70.3 (zanubrutinib) for bleeding, 5.4 (zanubrutinib), 6.2 (acalabrutinib) and 14.9 (ibrutinib) for AF, and 6.6 (acalabrutinib), 22.8 (ibrutinib) and 36.7 (zanubrutinib) for hypertension. Incidence rates of health outcomes related to AF (stroke and heart failure) were higher among ibrutinib-treated patients, whereas health outcomes related to hypertension (angina, myocardial infarction, heart failure and peripheral arterial disease) were higher among zanubrutinib-treated patients. Total direct medical costs per 100 CLL patients treated with BTKis over the first year were €38,803.10, €82,683.61, and €86,084.56 for acalabrutinib, zanubrutinib, and ibrutinib, respectively. In subsequent years, costs decreased to €20,429.78, €46,778.58, and €52,693.13 for acalabrutinib, zanubrutinib, and ibrutinib, respectively, which corresponds to a decrease of 39 to 47%.
CONCLUSIONS: The clinical and economic burden of cardiovascular toxicity from BTKis treatment in CLL patients is notable. Ibrutinib is associated with the highest costs and more frequent health consequences, while acalabrutinib revealed a lower overall impact.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO65
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas, Oncology