OBJECTIVES: Chronic lymphocytic leukemia (CLL) is the most frequent leukosis in adults. The majority of patients are older than 70 years, and many present with coexisting conditions. Patients with CLL and coexisting conditions have less favorable outcome. The main objective of the study was to perform health-economic evaluation of obinutuzumab plus chlorambucil in patients with CLL and coexisting conditions in comparison to ibrutinib.

METHODS: Research was conducted from a position of the state healthcare system by means of decision tree modeling with Markov cycles. Direct costs were considered. Cost-effectiveness analysis and sensitivity analysis were performed. Progression-free survival (PFS) by the end of the first modeling year, overall survival (OS), and overall response (OR) by the end of modeling period were used as the effectiveness criteria.

RESULTS: The use of obinutuzumab plus chlorambucil was characterized by smaller direct total cost (3 682 192 RUB/patient) in comparison with ibrutinib (12 453 527 RUB/patient): the difference in total costs for one patient reached 338% or 8 771 335 RUB at the modeling horizon of 27 months. The two drug strategy had comparable effectiveness: the difference in effectiveness criteria values did not exceed 10%. CER PFS, CER OS, and CER OR for obinutuzumab plus chlorambucil were considerably lower compared to ibrutinib (3 780 005 RUB vs 6 148 776 RUB; 4 046 364 RUB vs 12 707 680 RUB; 4 763 508 RUB vs 14 480 845 RUB, respectively). The results of budget impact analysis showed that in comparison to ibrutinib strategy, obinutuzumab strategy is more preferable, as it allows to save up to 877 133 516 RUB and to additionally treat up to 238 people. Sensitivity analysis confirmed the results of the baseline scenario.

CONCLUSIONS: CLL therapy of obinutuzumab plus chlorambucil in patients with coexisting conditions is cost-effective and resource-saving medical technology with a long-term prospect.