Frontline CLL: pricey ibrutinib delivers overall savings vs chemoimmunotherapy

  • Emond B, et al.
  • Clinical Lymphoma, Myeloma and Leukemia
  • 16 Aug 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In chronic lymphocytic leukemia (CLL), frontline ibrutinib monotherapy was associated with longer time to next treatment (TTNT) vs chemoimmunotherapy (CIT), including bendamustine+rituximab (BR).
  • Ibrutinib was associated with overall savings when factoring in medical costs.

Why this matters

  • Ibrutinib has demonstrated favorable outcomes vs CIT regimens; however, some concerns persist regarding ibrutinib’s high pharmacy cost.

Study design

  • Study to compare TTNT and costs in patients with CLL who received frontline ibrutinib monotherapy (n=322) or CIT (n=839) including BR (n=455).  
  • Funding: Janssen Scientific Affairs LLC

Key results

  • At 24 months follow-up, patients were significantly less likely to begin a subsequent line of therapy with ibrutinib monotherapy vs:
    • CIT: HR, 0.54; 95% CI, 0.33-0.90; P=.0163.
    • BR: HR, 0.54; 95% CI, 0.32-0.92; P=.0208.
  • Patients receiving frontline ibrutinib experienced fewer monthly days with outpatient visits: rate ratio, 0.75; P=.0200.
  • Ibrutinib was associated with higher pharmacy costs; however, these were dramatically offset by lower medical costs, resulting in a net mean monthly all-cause cost savings of $3766 (P<.0001 vs cit and br.>

Limitations

  • Patients receiving ibrutinib may have been more likely to have unfavorable cytogenetics.