Cost-effectiveness of targeted treatment vs chemoimmunotherapy in treatment-naive unfit CLL without <i>TP53</i> aberrations

Slot, Matilde; Niemann, Carsten Utoft; Ehlers, Lars Holger; Rotbain, Emelie Curovic

doi:10.1182/bloodadvances.2023010108

Cited by 2 publications

(1 citation statement)

References 42 publications

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“…Markov analyses have also been used to assess the cost-effectiveness of different treatment approaches. Yamamoto et al 12 compared the incremental cost-effectiveness ratio of various tyrosine kinase inhibitors for the treatment of CML, and Slot et el 13 compared the incremental cost-effectiveness ratio of ven-obinutuzumab vs ibrutinib for the treatment of chronic lymphocytic leukemia.…”

Section: Methodsmentioning

confidence: 99%

A Markov analysis of azacitidine and venetoclax vs induction chemotherapy for medically fit patients with AML

Ravindran,

Mozessohn,

Cheung

et al. 2024

Blood Advances

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While induction chemotherapy (IC) is the standard of care in medically-fit patients with newly diagnosed acute myeloid leukemia (AML), limited retrospective data indicate that adverse risk patients may benefit from azacitidine and venetoclax (aza-ven). Our goal was to perform a Markov decision analysis to determine whether IC or aza-ven is the optimal induction regimen in this population. Using the TreeAge software, Markov models were created for adverse risk and intermediate risk cohorts. A systematic review of the literature informed the transition probabilities and utilities included in the analyses. Our primary outcome was quality adjusted life years (QALY) gained over five years following diagnosis. Overall, adverse risk patients treated with IC gained 1.4 QALY, compared to 2.0 QALY in patients treated with aza-ven. Adverse risk patients treated with IC and allogeneic stem cell transplant (AlloSCT), IC, aza-ven and AlloSCT, and aza-ven gained 2.1, 1.5, 3.0, and 1.9 QALY, respectively. Meanwhile, intermediate risk patients treated with IC gained 2.0 QALY, compared to 1.7 QALY in patients treated with aza-ven. Intermediate risk patients treated with IC and AlloSCT, IC, aza-ven and AlloSCT, and aza-ven gained 2.7, 2.3, 2.6, and 1.8 QALY, respectively. We have demonstrated that medically-fit patients with newly diagnosed adverse risk AML may benefit from treatment with aza-ven over IC, while IC remains the preferred approach for intermediate risk patients. Our work challenges the use of the European LeukemiaNet risk classification in patients treated with aza-ven and highlights the need for prospective investigation into aza-ven as induction therapy for medically-fit patients.

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Section: Methodsmentioning

confidence: 99%

A Markov analysis of azacitidine and venetoclax vs induction chemotherapy for medically fit patients with AML

Ravindran,

Mozessohn,

Cheung

et al. 2024

Blood Advances

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

Urso,

Cavazzini,

Ballardini

et al. 2023

Cancers

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Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability.

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Cost-effectiveness of targeted treatment vs chemoimmunotherapy in treatment-naive unfit CLL without TP53 aberrations

Cited by 2 publications

References 42 publications

A Markov analysis of azacitidine and venetoclax vs induction chemotherapy for medically fit patients with AML

A Markov analysis of azacitidine and venetoclax vs induction chemotherapy for medically fit patients with AML

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

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