OBJECTIVES: Although oral targeted therapy (OTT) for chronic lymphocytic leukemia (CLL) represents an improved therapeutic strategy, this approach is accompanied by a major challenge related to the economic burden on the healthcare system. The objective of this study was to estimate future direct costs, as well as the prevalence, of CLL in the era of OTT in Canada.

METHODS: The economic burden of OTT compared to chemoimmunotherapy (CIT) for treating patients with CLL was assessed from 2011 to 2025. For the OTT scenario, CIT was considered the standard of care before 2015, while OTT was considered for CLL patients with either unmutated immunoglobulin heavy-chain variable (IGHV) or del(17p)/TP53 mutations starting in 2015 and, from 2020 onwards, for all first-line treatments except for patients with mutated IGHV. A Markov model was developed including four health states: watchful-waiting, first-line treatment, relapse and death. Costs of therapy, follow-up/monitoring and adverse event were included. Key clinical parameters were extracted from pivotal clinical trials.

RESULTS: As incidence rates and rate of survival are increasing, the prevalence of CLL in Canada is projected to increase from 8,301 in 2011 to 14,654 by 2025 (177% increase). Correspondingly, the total annual costs of CLL management will increase from $60.8 million to $957.5 million from 2011 to 2025, respectively (15.7-fold increase). With the implementation of OTT as a first-line treatment option, the per patient lifetime cost of CLL, for treated and untreated, is projected to increase from $4,036 to $43,309 (10.7-fold increase).

CONCLUSIONS: While OTT enhances survival for CLL patients, it is nonetheless associated with an important economic burden due to the projected vast increase in costs from 2011 to 2025. Changes in clinical strategies, such as implementation of a fixed OTT treatment duration or discontinuation and retreatment based on depth of response, would help alleviate financial burden.