ASH 2018: Dr. Chadi Nabhan on the Economic Impact of Venetoclax versus Chemo-immunotherapy (CIT) and Chemotherapy (CT) in CLL

We recently posted Dr. Nabhan’s research on the cost of ibrutinib versus CIT and CT in chronic lymphocytic leukemia.

At ASH 2018, Dr. Nabhan and I discussed his similar research on the cost of venetoclax versus CIT and CT in CLL.

The study only looked at relapsed or refractory (R/R) CLL patients, in other words, 2^nd line of therapy as during the time studied, venetoclax (VEN) was not approved for frontline use.

Claim based data was used to look at the total cost of care that included:

• ER visits
• Outpatient visits
• Hospitalization

There are many shortcomings of the research:

• Drug cost was not part of this analysis
• As it was only claims data, there could be no risk stratification as to high versus low risk patients

Takeaways:

• 385 CLL patients considered in this study between 1/01/2016 – 3/31/2018
• 154 were treated with VEN (median age 64 years, range: 21-79)
• 121 were treated with CT (median age 70 years, min 19 and max 79)
• 110 were treated with CIT (median age 65 years)
• The total cost of medical care was significantly higher in both the CT and CIT groups when compared to VEN ($6,075.81 and $5,514.52 vs $2,439.52, p-value <0.0001)

Conclusions:

In R/R CLL patients, venetoclax is more cost effective that chemo or chemo-immunotherapy, but there are difficulties about how to include all the costs when doing these analyses that we discussed in the interview.

I echo Dr. Nabhan’s pleas that all clinical trials should include a secondary end point of the total cost of care. And also include PROs or patient reported outcomes.

Finally, as we pointed out before, why were 121 patients getting old school chemotherapy when, in all circumstances, novel agents or chemo-immunotherapy is superior.

Here is the ASH 2018 interview with Dr. Nabhan:

Here is the link to the ASH abstract.