OBJECTIVES: To compare real-world healthcare resource utilization (HRU) and costs between patients with chronic lymphocytic leukemia (CLL) initiated on first-line (1L) ibrutinib or acalabrutinib.

METHODS: Adults with CLL initiated on 1L ibrutinib or acalabrutinib monotherapy (index date) on or after acalabrutinib approval for CLL (11/21/2019) were analyzed using electronic medical records from the Acentrus database (11/21/2018-4/30/2022). Per-patient-per-month (PPPM) HRU and costs were evaluated during 1L therapy and compared between ibrutinib and acalabrutinib using multivariate regression models.

RESULTS: Among 710 and 373 patients initiated on ibrutinib and acalabrutinib, respectively, mean age (ibrutinib vs. acalabrutinib: 71.5 vs. 72.4 years, P=0.159), sex (38.5% vs. 38.3%, P=0.971), and mean Quan-Charlson Comorbidity Index (3.1 vs. 3.0, P=0.597) were similar. Median duration of 1L was longer for ibrutinib (16.5 vs. 10.2 months, P<0.001). During 1L therapy, the mean number of inpatient days was similar for both cohorts (0.42 vs. 0.49 days PPPM, rate ratio [RR]=1.00, P=0.966), while the number of outpatient visits was significantly lower for ibrutinib compared to acalabrutinib (1.47 vs. 2.06 days PPPM, RR=0.76, P<0.001). Similar results were observed for CLL-related HRU (inpatient: RR=0.87, P=0.758; outpatient: RR=0.80, P=0.036). Mean total healthcare costs were significantly lower for ibrutinib compared to acalabrutinib (all-cause: $14,691 vs. $16,599 PPPM, mean monthly cost difference [MMCD]=-$1,355, P=0.004; CLL-related: $12,186 vs. $13,715 PPPM, MMCD=-$1,215, P=0.004). Results were consistent for the first 3 months (RR for outpatient=0.76, P<0.001; MMCD for total costs=-$810, P=0.120), 6 months (RR=0.77, P<0.001; MMCD=-$1,040, P=0.044), and 12 months (RR=0.76, P<0.001; MMCD=-$1,417, P<0.001), and among the subgroup with baseline atrial fibrillation (RR=0.53, P=0.044; MMCD=-$2,834, P=0.309).

CONCLUSIONS: 1L CLL patients treated with ibrutinib had lower number of days with outpatient services and lower costs compared to acalabrutinib. These findings have important implications for optimal 1L BTKi selection. Additional research is warranted to understand reasons behind differences in HRU/costs between 1L ibrutinib and acalabrutinib.