Ibrutinib in Chronic Lymphocytic Leukemia Deemed Not Cost-Effective by ICER Standards
No direct comparison between ibrutinib and chemoimmunotherapy as a first-line treatment exists.
Ibrutinib is not a cost-effective therapeutic option per quality-adjusted-life-year (QALY) among patients with chronic lymphocytic leukemia (CLL) compared with a comparator, according to a study published in Blood Advances.1
Bruton's tyrosine kinase inhibitors (TKI), such as ibrutinib, have greatly improved survival outcomes in CLL. Direct pharmacoeconomic studies however, have not been performed comparing ibrutinib and available first-line therapies, leaving the economic feasibility of ibrutinib in question.
For this study, researchers created a semi-Markov model to analyze results of the RESONATE-2 study (ClinicalTrials.org Identifier: NCT01722487) and the C9011 trial. The cost-effectiveness of ibrutinib — expressed in QALYs — was compared with a treatment modeled on the efficacy of chlorambucil alone and the costs and adverse events (AE) of chlorambucil plus obinutuzumab, the best available treatment alternative. Eligible patients were older than 65 years did not have a 17p deletion.
In the modeled cohort, the overall survival (OS) and progression-free survival (PFS) of patients treated with ibrutinib arm was 103 months and 79 months, respectively, and in the comparator arm was 58 months and 15 months, respectively. Ibrutinib therapy led to 5.49 QALYs compared with 3.09 QALYs in the comparator arm.
Results showed that the incremental cost-effectiveness ratio for ibrutinib was $189,000 per QALY gained versus the comparator. In order to reach the willingness-to-pay (WTP) threshold of $150,000 per QALY, the cost of ibrutinib would need to decrease to $6800 per month from the modeled cost of $8500 per month.
When the efficacy of the comparator arm was increased to match chlorambucil plus obinutuzumab, ibrutinib costs exceeded $262,000 per QALY gained, and would need to cost less than $5000 a month to be cost-effective, the researchers determined.
The authors concluded that “ibrutinib at its current price is unlikely to be cost-effective at what is an often-cited willingness-to-pay threshold for the US health care system of $150,000 per QALY.”
- Barnes JI, Divi V, Begaye A, et al. Cost-effectiveness of ibrutinib as first-line therapy for chronic lymphocytic leukemia in older adults without deletion 17p. Blood Adv. 2018;2:1946-1956.