ASH 2018: Dr. Chadi Nabhan on the Cost of Ibrutinib vs. Chemo vs Chemoimmunotherapy in CLL (chronic lymphocytic leukemia)

At ASH 2018 like all big hematology congresses, research is presented that is preclinical basic science, research that reports the results from well-designed clinical trials and research that looks at what happens in the real world.

Dr. Chadi Nabhan and I had spoken together on the economics and disparities of cancer care at a past Binay Foundation conference so I jumped at the chance to interview him about his real world research on the cost of CLL treatment that he presented at ASH 2018.

Takeaways:

• This was a large retrospective, observational study comparing the total cost of care for CLL pts treated between 2014- 2017, front line with either ibrutinib, or chemotherapy (CT), or chemoimmunotherapy (CIT).
• Data was collected from insurance claims and included not only drug costs, but also the costs of:
  • ER visits.
  • Outpatient visits.
  • Inpatient visits (admission to the hospital).
  • Cardiovascular events including atrial fibrillation (AF), a potential issue with ibrutinib.
• Results:
  • 1,464 patients received chemotherapy alone. This is a huge concern as there is virtually no role for chemotherapy on its own in CLL. In fact, there is very little role for CIT.
  • When you consider all the costs, ibrutinib was overall more cost effective.
  • More ibrutinib patients, about 4-5% developed AF and their cost of care was higher.

Conclusions:

It is important to look at more than just the cost of the medicine when determining the economics of any treatment as this retrospective study proves.

Both morbidity and cost could be further improved by looking at which CLL patients are at risk for AF (see this research by Dr. Mato on finding left atrial abnormalities on an EKG as an inexpensive predictive tool for gauging AF risk) and intervening to reduce their risk.

However, what is most concerning is a finding that was not the purpose of the trial but it screams out for attention.

Why did 1,464 chronic lymphocytic patients receive what was very likely inappropriate care, namely chemotherapy?

This is tragic,unacceptable, and must change.

That is why the CLL Society says Smart Patients Get Smart Care™. That is why we push you and help you with our programs such as Expert Access to get an expert second opinion.

Finally, the economics of therapies should be part of all trial designs, Phase 1, 2 3, or 4. Including the study of the total costs of different treatments upfront would offer stronger data than we get from retrospective studies such as this and could help inform what smart choices we can make to control costs and get the best results.

Here is my very short interview with Dr. Nabhan:

Here is the link to the actual abstract: Cost-Effectiveness Comparison between Ibrutinib, Chemotherapy, and Chemoimmunotherapy in Front-Line Treatment of Chronic Lymphocytic Leukemia (CLL)

This is such important work. Thanks for reading.

Brian