A Probabilistic Cost-Effectiveness Analysis of Venetoclax and Obinutuzumab as a First-Line Therapy in Chronic Lymphocytic Leukemia in Canada

Abstract

Background Venetoclax is a first-in-class targeted therapy option that is an inducer of apoptosis in chronic lymphocytic leukemia (CLL) cells. The open-label phase III CLL14 clinical trial showed that venetoclax combined with obinutuzumab (VEN+O) is superior to obinutuzumab combined with chlorambucil in newly diagnosed patients with CLL. The aim of this study was to assess the health economic value of VEN+O for the frontline treatment of CLL in Canada from a publicly funded healthcare system perspective. Methods A partitioned survival analyses model was developed including three health states: progression free, progressed, and death. A cycle length of 28 days and a time horizon of 10 years was assumed. VEN+O treatment for a fixed duration of 12 months was compared to obinutuzumab combined with chlorambucil, fludarabine plus cyclophosphamide plus rituximab, bendamustine plus rituximab, chlorambucil plus rituximab, ibrutinib, and acalabrutinib. The population in the model included both unfit and overall frontline CLL patients, two subgroups were also assessed (patients with del17p/TP53 mutations and patients without del17p/TP53 mutations). Survival data extrapolated from the CLL14 trial were used to populate the model. Uncertainty was assessed via one-way sensitivity analyses, probabilistic analyses, and scenario analyses. Results Based on the probabilistic analyses, unfit frontline CLL patients receiving VEN+O were estimated to incur costs of Canadian dollars

First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era

“…A company-sponsored probabilistic analysis showed that with a willingness to pay USD 50,000/QALY gained in Canada, VEN + O has the greatest probability of being costeffective as compared with Chlor + O, BR, ibrutinib, and acalabrutinib [89]. Likewise, acalabrutinib monotherapy showed a 59% to 73% probability of being cost-effective vs. Chlor + O at a USD 100,000-to-150,000/QALY gained in the U.S. in a company-sponsored analysis [90].…”

The net clinical benefit of targeted agents in the upfront treatment of elderly/unfit chronic lymphocytic leukemia patients: Results of network meta‐analysis

“…A recent probabilistic costeffectiveness analysis of first-line therapy of CLL in Canada suggests that VO is a cost-effective treatment option for unfit frontline CLL patients and provides value for money to healthcare payers. 21 However, cost studies of TAs in CLL are limited by short follow-up times that did not capture the full impact of treatment costs. When more robust cost-effectiveness analyses will be available they will provide further insights into the choice of best TAs for personalized upfront therapy in CLL.…”