OBJECTIVES: To perform a cost-minimization and budget impact (BI) analysis of venetoclax + obinutuzumab (VenO), venetoclax + rituximab (VenR), versus acalabrutinib monotherapy (acala) in the 1L and relapse or refractory (R/R) chronic lymphocytic leukemia (CLL) treatment from the Brazilian Private Healthcare perspective.

METHODS: The network meta-analysis from Molica et al., presented similar overall survival (OS) and progression-free survival (PFS) between VenO and acala in 1L-CLL. The head-to-head trial comparing acala and ibrutinib (Byrd JC et al.) and the indirect comparison of VenR with B-cell receptor inhibitors (Mato A et al.,) were used as assumption of similar efficacy between VenR and acala in R/R-CLL. Considering the similar efficacy, a cost-minimization model was developed, and it included only the drug acquisition costs based on 2022 Brazilian list price. Total treatment cost over 5 years were compared. The BI model was performed for the treatments included in this study and considering the total estimated patients in the private market over 5 years.

RESULTS: VenO and VenR are associated with a per-patient cost saving up to BRL 2.209.470 (-77%) and BRL 1.713.068,11 (-60%) compared to acala for 1L and R/R CLL. Thus, in scenarios considering only VenO/ VenR or Acala usage the BI analysis presented an accrued cost saving over 5 years of BRL 1.971.178.004 and BRL 511.434.675 in favor of VenO/VenR in 1L and R/R respectively. Whitin this scenario VenO and VenR can reach a total cost saving up to BRL 2.482.612.679 over 5 years depending on the patient market share and treatment duration.

CONCLUSIONS: Results of the analysis indicate VenO and VenR associated with lower treatments costs in both scenarios with a higher resource saving for 1L CLL patients. Venetoclax fixed treatment duration regimens can generate resource-savings and have the potential to reduce the CLL BI for the Brazilian Private Healthcare System.