OBJECTIVES

: To perform an economic evaluation of acalabrutinib use in adult patients with Mantle Cell Lymphoma (MCL) who have received at least one previous therapy from the perspective of public health institutions in Mexico.

METHODS

: A cost-effectiveness analysis of acalabrutinib compared to ibrutinib was performed using a partitioned survival Markov model consisting of three health states: progression-free survival, post-progression, and death. The proportion of patients in each state was calculated based on parametric distributions fitted to PFS data from ACE-LY-004 for acalabrutinib and Wang, 2015 for Ibrutinib. Through this model, the gained Life Years (LYs) were calculated for each of the interventions considering a time horizon of 15 years. The perspective of the public health sector as payer was considered, so only direct medical costs associated with each intervention were calculated, including: drug acquisition, adverse events management and subsequent therapies. Health costs and outcomes were discounted at a rate of 5%, aligned to local guidelines. All cost are expressed in US dollars. Deterministic and probabilistic analyzes were carried out.

RESULTS

: Over a time horizon of 15 years, the use of acalabrutinib generates a total cost of $191,546 (75% attributed to drug acquisition costs) per patient versus $204,636 per patient generated with ibrutinib. The efficacy analysis shows that treatment with acalabrutinib is associated with an incremental gain of 1.07 life-years. When comparing this result with the savings from acalabrutinib versus ibrutinib, derives in a negative incremental cost-effectiveness ratio of $-12,233. Additionally, the sensitivity analyses results were consistent with the base case.

CONCLUSIONS

: Given a willingness-to-pay (WTP) threshold of $8,472 in Mexico, acalabrutinib compared to ibrutinib is a dominant alternative in the treatment of patients with MCL who have received at least one previous therapy due to a better clinical effectiveness profile and savings generated from resource use.