OBJECTIVES: A cost-effectiveness analysis was performed to compare fixed duration venetoclax + rituximab with other treatments for the treatment of relapsed/refractory chronic lymphocytic leukemia in the public healthcare sector of four Gulf countries.

METHODS: An existing model using a three-state partitioned survival framework was adapted to the public healthcare sector in Kuwait, Oman, Qatar and the United Arab Emirates (UAE). Inputs included disease epidemiology and local cost of treatment obtained via literature review and a two-round Delphi technique. Unit costs of medications, treatment administration, routine care and monitoring, and adverse event prophylaxis and management were considered. The time horizon for the cost-effectiveness model was 30 years (lifetime time horizon) and a discount rate of 3.5% was applied to costs and outcomes. Comparators included in the model were ibrutinib, fludarabine + cyclophosphamide + rituximab (FCR), bendamustine + rituximab (BR), ibrutinib + BR and acalabrutinib.

RESULTS: In Kuwait, Qatar, Oman and United Arab Emirates, venetoclax + rituximab is a dominant strategy compared to acalabrutinib, ibrutinib and ibrutinib + BR due to the lower incremental cost (-$242,455, -$242,148, -$398,254 for Kuwait; -$292,609, -$134,051, -$243,747 for Qatar; -$46,921, -$47,892, -$194,793 for Oman; -$574,592, -$117,772, -$244,443 for UAE) and more QALYs gained (1.929, 1.928, 1.173 for Kuwait; 1.814, 1.813, 1.117 for Qatar; 1.473, 1.472, 0.921 for Oman; 1.851, 1.850, 1.129 for UAE), but not cost-effective compared to FCR or BR, due to the lower cost related to treatment with FCR and BR, despite the QALY gains for venetoclax + rituximab, at willingness-to-pay thresholds of 1 x GDP per capita ($32,373 for Kuwait, $50,806 for Qatar, $15,343 for Oman, $43,101 for UAE).

CONCLUSIONS: Venetoclax + rituximab as a fixed treatment duration regimen is a cost-effective treatment option compared to BTK inhibitors (acalabrutinib and ibrutinib) in the Gulf region.