OBJECTIVES: The availability of orally administered BTKis (e.g., ibrutinib, acalabrutinib) and recently fixed-duration BCL-2 inhibitors (i.e., venetoclax) have transformed treatment for chronic lymphocytic leukemia (CLL). However, these novel drugs have not been compared in the real-world setting. This study aimed to compare healthcare resource utilization (HRU) and costs in older adults with relapsed/refractory (R/R) CLL receiving venetoclax vs. BTKis.

METHODS: Our retrospective cohort study used 2015-2019 100% Medicare Part A/B/D claims, to identify beneficiaries age ≥66 years newly initiating venetoclax or BTKi for R/R CLL between 1/1/2016 and 12/31/2018. All-cause and CLL-related HRU and costs in the 12-months after treatment initiation were examined. Risk-adjusted outcomes controlling for differences in sociodemographic and clinical factors were estimated using logistic regressions (HRU) and generalized linear models (costs).

RESULTS: The final sample included 2277 patients (711 venetoclax group; 1566 BTKi group). Compared to the BTKi group, the venetoclax group tended to be younger (mean age 75.6 vs 77.6 years, p<0.001) but had poorer clinical characteristics (for example, 39.4% vs. 30.4% with ≥8 comorbidities [p<0.001]). Risk-adjusted rates of all-cause (63.7% vs. 50.9%) and CLL-related (60.2% vs. 43.9%) hospitalization were higher in the venetoclax vs. BTKi group (p<0.001 for all). Over 80% of all-cause costs were CLL-related for both groups. Risk-adjusted CLL-related medical costs were higher ($47,436 vs. $28,542, p<0.001) and CLL-related prescription costs were lower ($87,757 vs. $114,964, p<0.001) in the venetoclax vs. BTKi group, respectively. Overall, the venetoclax group had lower risk-adjusted CLL-related total costs compared to BTKi patients (-$8,313, p<0.001). Similar patterns were found for all-cause costs with total costs being lower in the venetoclax group (-$13,628, p<0.001).

CONCLUSIONS: In this real-world study utilizing national Medicare data, older adults with R/R CLL initiating venetoclax had lower total all-cause and CLL-related costs than BTKi initiators during the 12-months following treatment initiation, largely driven by differences in prescription costs.