Researchers performed a cost-comparative analysis among ibrutinib; chemotherapy (CT) alone, including monoclonal antibodies; or chemoimmunotherapy (CIT) as first-line chronic lymphocytic leukemia treatment. The study was conducted using a retrospective, observational design. The primary end point was to compare healthcare resource utilization (HRU) of patients in each cohort, whereas the secondary objective was to quantify the incidence of cardiovascular (CV) adverse events among patients who did not have any CV disease prior to treatment initiation.
Patients were selected from a large claims database representative of the US population across age, sex, geography, and insurance type. To be eligible for inclusion, patients were at least 18 years of age and started therapy after January 1, 2014, and before November 30, 2017, to allow for at least 3 months of follow-up. Patients were excluded if they had any CV events, including hypertension, myocardial infarction, atrial fibrillation, peripheral vascular disease, and coronary artery disease, during the 12-month period before entering the study.
After excluding noneligible patients, cohorts included 4368 patients receiving ibrutinib, 1464 receiving CT, and 2176 treated with CIT. Baseline characteristics were similar in all 3 cohorts. Median time from diagnosis to treatment was significantly longer in ibrutinib-treated patients versus CT and CIT (17.4 months vs 10.9 months; and vs 7.8 months, respectively; P <.0001).
Not surprisingly, patients treated with CT and CIT had significantly higher outpatient costs and HRU compared with ibrutinib patients (P <.0001). Inpatient visits, costs, and length of stay were significantly different in patients receiving CIT compared with ibrutinib, but not in CT-treated patients. Emergency department (ED) visits were significantly higher for both CT- and CIT-treated patients (P <.05), whereas ED costs were slightly higher for ibrutinib patients, but the difference was not statistically significant.
A total of 567 (13%) patients receiving ibrutinib went on to have a CV event, whereas 3801 patients continued therapy without an event. As expected given the established safety profiles of these therapies, more patients receiving ibrutinib developed atrial fibrillation compared with CIT-treated patients (4.42% vs 2.67%; P = .0005).
In first-line treatment, ibrutinib has lower HRU and ED visits than CT or CIT. However, CV events in ibrutinib-treated patients were observed in 13% of patients and significantly affected cost and resource utilization.
Nabhan C, et al. ASH 2018. Abstract 4757.