OBJECTIVES

: Venetoclax label was recently expanded in the United States (US) to include the use of venetoclax in combination with rituximab (R) for 24-months fixed duration in patients with relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL). Our study aims to estimate the 3-year budgetary consequence of the expanded indication from the perspective of a US payer with 1,000,000 members.

METHODS

: The model included venetoclax monotherapy, ibrutinib, idelalisib + R and bendamustine + R as comparators. Dosing regimen, treatment duration, and safety data were extracted from package inserts. Total cost of care was estimated for each regimen and included drug costs, wastage, drug administration, adverse events, monitoring, and routine care. Drug costs were obtained from the Truven Health Analytics Red Book whereas other costs were based on published literature and a MarketScan analysis (Copyright © 2018 Truven Health Analytics LLC. All Rights Reserved.) Monitoring costs were applied to venetoclax ± R for ramp up management and idelalisib + R for liver function monitoring and pneumonitis. Scenario analyses explored uncertainty in influential parameters. Outcomes were presented in absolute incremental budget impact and per-member per-month budget impact (PMPM).

RESULTS

: Over the three-year time horizon, the expanded indication of venetoclax was associated with a total cost saving of $798,601 or an average PMPM of -$0.0219. By Year 3, the cumulative difference in total cost of care of venetoclax + R compared with idelalisib + R, and ibrutinib is -$105,941, and -$100,391, respectively. Scenario analyses supported the base case findings.

CONCLUSIONS

: From a US payer’s perspective, the expanded indication of venetoclax for a 24 month fixed duration was associated with a cost saving of $798,601 in patients with R/R CLL over a three-year period. The 24-month fixed duration of venetoclax + R was a key driver in reducing total cumulative treatment costs.