OBJECTIVES: To assess the 2 years costs of venetoclax in combination with rituximab (V+R) for treating relapsed or refractory Chronic Lymphocytic Leukemia (R/R CLL) compared to ibrutinib using price-data from Brazilian Health Regulatory Agency (Anvisa) under Brazilian private healthcare system perspective.

METHODS: The economic analysis compares two treatment options based exclusively on their list prices, including 18% (PF18%) of Tax on Circulation of Goods and Transportation and Communication Services (ICMS). Due to lack of direct-comparisons and limitations of indirect analysis, it was applied similar efficacy results in clinical practice. For calculating the annual cost per treatment per patient it was analyzed the monthly cost of each product, dosage and administration according to manufacturer’s labels of venetoclax, rituximab and ibrutinib. Cost-minimization model compared, in terms of incremental costs, the total treatment costs in 24 months. It was also included a sensitivity analysis, varying products’ prices down to 10%. A superior threshold was not considered, once PF18% is the maximum applicable price according to Brazilian regulation. In an additional analysis of the cost-minimization model it was adapted the criteria aforementioned to the premises used by National Institute for Health and Clinical Excellence (NICE) regarding the median of treatment duration of V+R (22 months) versus ibrutinib (56 months).

RESULTS: Over 2 years, the incremental cost saving was R$57,194.35 for patient treated with V+R. In the first year, even considering the addition of rituximab, V+R offers a saving of R$8,000 (2%) per patient. In the second year the saving goes up to R$49,000 (11%). Considering NICE’s appraisal premises for treatment duration, the incremental cost-saving with V+R was R$1,2 million per patient compared to ibrutinib.

CONCLUSIONS: The combination of venetoclax+rituximab is a cost-saving alternative compared to ibrutinib for treating relapsed or refractory Chronic Lymphocytic Leukaemia (R/R CLL) in the Brazilan private heathcare system.