OBJECTIVES : Multiple phase 3 trials have demonstrated significant PFS and OS benefit with 1L ibrutinib treatment in CLL vs commonly-used chemoimmunotherapy (CIT) regimens. In addition, several real-world studies have compared 1L ibrutinib to previous standards of care to provide complementary information. Therefore, to identify, select, critically appraise, and summarize economic outcomes with 1L ibrutinib, we conducted a systematic literature review that qualitatively synthesizes healthcare resource utilization (HRU) and costs associated with 1L ibrutinib treatment for CLL/SLL.

METHODS : A systematic literature search (Embase, Medline, and relevant conference websites) for publications indexed January 2014–June 2020 was conducted per PRISMA guidelines via a dual-screening process.

RESULTS : Fourteen publications reported ibrutinib-associated all-cause HRU and/or direct costs. Studies represented a diverse CLL/SLL patient population for characteristics including age and insurance type. Thirteen of fourteen studies compared HRU and/or costs between 1L ibrutinib vs CIT. Ibrutinib was associated with significantly lower outpatient HRU and similar inpatient and emergency room (ER) HRU vs CIT (rate ratios range: outpatient 0.47–0.86, P<0.05; inpatient 0.38–1.4, P>0.05; ER 0.57–1.22, P>0.05). Ibrutinib had significantly lower medical costs (mean-monthly-cost-difference [MMCD]: -$5,888 to -$18,717, P<0.05) and significantly higher pharmacy costs vs CIT (MMCD: $4,878 to $12,232, P<0.05). The total direct cost for ibrutinib was significantly lower than for CIT (MMCD: -$996 to -$17,104, P<0.05).

Full-text manuscripts (n=3) or posters (n=5) were available for 8 of the 14 publications for which quality was evaluated and deemed acceptable using the ISPOR checklist. HRU/costs results tended to be congruent with overall publications.

CONCLUSIONS : A systematic literature review of real-world evidence suggests 1L ibrutinib for CLL/SLL is associated with lower HRU predominantly driven by lower outpatient visits when compared to CIT. Correspondingly, higher ibrutinib pharmacy costs were completely offset by lower overall medical costs resulting in total net savings associated with 1L ibrutinib use vs CIT for CLL/SLL.