This study sought to compare real-world healthcare resource utilization (HRU), costs, and time to next treatment (TTNT) following initiation of first-line ibrutinib monotherapy versus chemoimmunotherapy (CIT), focusing on the combination of bendamustine and rituximab (BR).
A proprietary national health insurer claims database was used to identify adults with confirmed chronic lymphocytic leukemia (CLL) initiating frontline ibrutinib or National Comprehensive Cancer Network–recommended CIT regimens/CD20 antibody agents beginning in February 2014. To be eligible, patients were required to be continuously enrolled for at least 12 months before the study index date and at least 30 days after the index date. Patients’ baseline characteristics were balanced using inverse probability of treatment weighting. HRU, costs, and TTNT were evaluated over the duration of frontline therapy. TTNT was defined as the time from initiation of first-line treatment to the initiation of a new antineoplastic agent that was not part of the first-line regimen. Of the 1161 frontline patients included in the analysis, 322 initiated ibrutinib and 839 initiated CIT, including 455 on BR. After weighting, cohorts had comparable baseline characteristics.
When evaluating TTNT, researchers reported that 88.6% and 89.0% of ibrutinib patients did not initiate a new treatment compared with 75.9% and 79% among CIT and BR patients, respectively. The hazard ratios were statistically significant for both of these comparisons.
An evaluation of healthcare costs during the frontline therapy period revealed that relative to the CIT cohort, the higher pharmacy costs incurred by ibrutinib patients were fully offset by lower medical costs, resulting in a net monthly total cost reduction of $3766. Greater savings were seen when the ibrutinib cohort was compared with the BR cohort, with a total monthly cost reduction of $5569 per patient compared with BR patients. A closer analysis revealed that ibrutinib patients had fewer outpatient visits compared with CIT and the subset of BR patients, due largely to avoidance of drug administration–related outpatient visits.
In frontline treatment, researchers concluded that the total cost of care for ibrutinib was significantly lower than for either CIT or BR, with longer TTNT. Furthermore, consistent with the high rates of progression-free survival observed among ibrutinib patients in clinical trials, nearly 90% of patients did not initiate a new treatment after 24 months of follow-up. These findings may have economic implications for health insurers and other healthcare stakeholders evaluating the cost of frontline CLL treatment.
Wang S, et al. ASH 2018. Abstract 2306.