A COST-EFFECTIVENESS ANALYSIS OF BENDAMUSTINE AT A TERTIARY CANCER CENTER

OBJECTIVES This study evaluates the cost-effectiveness and budget impact of bendamustine, a recently approved alkylating mechlorethamine derivative for the treatment of chronic lymphocytic leukemia (CLL), as part of the Formulary Management System at a major tertiary cancer center in the United States. METHODS Decision analytical models were developed to estimate the cost-effectiveness of bendamustine in CLL patients receiving either first-line or salvage therapy. The first-line model compared bendamustine alone versus a combination therapy of fludarabine, cyclophosphamide, and rituximab (FCR). The salvage model also compared bendamustine alone to the same FCR combination for CLL therapy. The outcome of interest was progression-free life years (PFLY), based on published literature and clinical use estimates. Direct institutional medical costs for a one-year time period were utilized. In addition, a budget impact analysis was also conducted for adding bendamustine to the Formulary. RESULTS Bendamustine is more convenient - only a single infusion is required compared to multiple infusions for the FCR combination. However, based on outcome estimates from literature and the application of the institutional costs, bendamustine was found to be less costly and also less effective. The cost per PFLY saved by using the FCR combination for treatment of CLL for first-line therapy was $2964. The cost was $5553 per PFLY saved for the same FCR combination for the treatment of CLL in salvage therapy. The budget impact model showed that the institution will utilize about $6.43 million worth of bendamustine annually based on acquisition costs and estimated usage. CONCLUSIONS Bendamustine appears to be less cost-effective than other therapeutic regimens for the treatment of CLL. Bendamustine was added to the Formulary as a second- or third-line option for both model indications. Future economic analyses will be conducted to determine how closely the current economic model predicts actual utilization and cost-effectiveness at the institution.