The Economic Impact of Treatment Sequencing in Chronic Lymphocytic Leukemia in Canada Using Venetoclax plus Obinutuzumab

Simple Summary Bruton tyrosine kinase inhibitors agents are administered continuously until disease progression or unacceptable toxicity, raising concerns about their affordability. Considering the rapidly evolving treatment landscape in chronic lymphocytic leukemia (CLL), ongoing evaluation of CLL treatment sequencing is vital for optimal patient management while ensuring fiscal sustainability. Venetoclax + obinutuzumab (VO) is a fixed-duration treatment (12 months) which has the potential to reduce the cost burden of treating CLL. The aim of this study was to estimate the cumulative cost of different treatment sequences and evaluate the economic impact of introducing treatment sequences with/without VO, from a Canadian health care system perspective. Results highlight that treatment sequences with time-limited therapy VO in first-line resulted in lower costs compared to sequences without VO. Given the expected increase in spending on CLL treatments in Canada, this study indicates a possible strategy to mitigate these rising costs in a publicly funded health care system.Abstract Background: Bruton tyrosine kinase inhibitors (BTKis) represent an advancement in chronic lymphocytic leukemia; however, these agents are administered continuously until disease progression or unacceptable toxicity, raising concerns about their affordability. Venetoclax in combination with obinutuzumab (VO) is a fixed-duration (12-month) treatment, approved in Canada in 2020. This study estimated the total cumulative cost of different treatment sequences and evaluated the economic impact of introducing treatment sequences with/without VO, from a Canadian health care system perspective. Methods: A 10-year partitioned survival model was developed, considering key clinical parameters and direct medical costs. Results were stratified by TP53 aberration. Results: Treatment sequences starting with first-line (1L) VO resulted in lower 10-year cumulative costs compared to sequences starting with BTKis administered until disease progression, across both TP53 aberration subgroups. With a maximum of three lines of treatment over a 10-year period, cumulative costs were largely determined by the first two lines of treatment. When comparing sequences with the same 1L treatment, sequences with BTKis in second-line incurred greater costs compared to fixed-duration regimens. Conclusions: Overall, the economic impact of treating all patients with VO led to 10-year cumulative savings of CAD 169,341 and CAD 293,731 per patient, without and with TP53 aberration, respectively. These savings are mainly due to reductions in treatment costs associated with fixed treatment duration.