Oral Therapy Costs for CLL Creating Financial Toxicity for Patients


Patients with chronic lymphocytic leukemia (CLL) are often treated with oral targeted therapies, which tend to be highly effective yet financially burdensome, according to research published by the Journal of Clinical Oncology.


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The US Food and Drug Administration have approved a few oral targeted therapies for the treatment of CLL in recent years. Novel therapies such as ibrutinib, idelalisib in combination with rituximab, and venetoclax have revolutionized the CLL treatment landscape. However, these targeted therapies are associated with high costs, raising concerns for payers and patients.

In an attempt to project the changing economic and disease burden of CLL in this era of targeted therapies and to evaluate the affordability and value of these new therapies, researchers led by Qiushi Chen, PhD, Georgia Institute of Technology, developed a microsimulation model to study the dynamics of the CLL patient population in the United States from 2011-2025. Researchers used chemo-immunotherapy as the standard of care before 2014, oral targeted therapies for patients with CLL from 2014, and for first-line treatment from 2016 onward. A scenario was simulated where chemo-immunotherapy remained the standard of care throughout the timeframe for comparison purposes. Disease progression and survival parameters for each therapy were based on data from published clinical trials.

Results of the study project the number of people living with CLL to increase from 128,000 in 2011 to 199,000 (55% increase) in 2025 due to improved survival as a result of oral targeted therapies. If chemo-immunotherapy had remained the standard of care, as in the second simulated scenario, the number of people living with CLL would be 162,000 (26% increase) by 2025.

However, the annual cost of CLL management is projected to increase from $0.74 billion to $5.13 billion (590% increase) as a result of oral targeted therapies being standard of care. The per-patient lifetime cost of CLL oral treatment is projected to increase from approximately $147,000 to $604,000 (310% increase). Out-of-pocket costs are projected to increase from approximately $9200 to $57,000 (520% increase) for patients enrolled in Medicare. In comparison to the chemo-immunotherapy scenario, the cost-effectiveness ratio of oral targeted therapies is expected to be $189,000 per quality-adjusted life-year.

Researchers concluded that while the oral targeted therapies are projected to increase CLL survivorship over time, the therapies will simultaneously impose a significant financial burden on payers and patients. For patients with CLL to avoid financial toxicity, further efforts are necessary to enact sustainable pricing strategies for these therapies.