Authored by Ann Liu, PhD
Medically Reviewed by Brian Koffman, MDCM (retired), MSEd
The Bottom Line:
Researchers used modeling to show that fixed-duration therapy would reduce five-year costs for patients with CLL compared with continuous therapy.
Who Performed the Research and Where Was it Presented:
Dr. Farrukh Awan from the University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting in 2025.
Background:
Patients with chronic lymphocytic leukemia (CLL) / small lymphocytic lymphoma (SLL) now have many good treatment choices. Some therapies like BTK inhibitors (ibrutinib, acalabrutinib, zanubrutinib) are given continuously until disease progression. Other therapies like venetoclax-based combinations are given for a fixed duration of time. Both continuous and fixed-duration therapies have both been shown to offer durable disease control, and researchers wanted to compare the costs of the two different types of therapy. This study compared the health care costs of continuous BTK inhibitors (BTKi) versus fixed-duration acalabrutinib-ventoclax.
Methods and Participants:
Researchers developed a budget impact model, which covered five years and included a number of different variables such as treatment duration, drug costs, office visit costs, lab test costs, costs for managing side effects, etc. They used this model to compare estimated costs for individual patients receiving either continuous BTKi therapy or fixed-duration acalabrutinib-venetoclax therapy. They also estimated how costs to treat CLL patients would change for a health plan assuming a scenario with a gradual increase in use of acalabrutinib-venetoclax.
Results:
- Compared with continuous BTKi therapy, fixed-duration acalabrutinib-venetoclax therapy would save the payor (usually the insurance company or health plan) $618,849 over five years for an individual patient.
- While the initial costs in year one would be higher with acalabrutinib-venetoclax therapy (+$160,757) compared with continuous BTKi therapy, costs would be lower in year two as patients completed the 13 month treatment period ($184,254 less than BTKi), and decrease even further in years three to five ($198,451 less than BTKi).
- In the health plan scenario, the estimated reduction in cost for the health plan was $19,539 per diagnosed CLL patient, or a lower cumulative cost of $722,943 for the whole health plan over five years.
- All of these calculations are based on the still to be proven assumption that the patient who receives fixed duration therapy would not relapse to the point where they would need retreatment over the five years.
Conclusions:
While efficacy and safety are always the most important factors when choosing a therapy for CLL, cost can also be a major concern for patients. In this study, researchers used modeling with optimistic assumptions to show that fixed-duration therapy would reduce five-year costs for patients with CLL compared with continuous therapy. Also, this research did not try to answer the question as to whether one therapy would be less costly to the patient. What it did was calculate the cost to the health system. Still, this provides new information for patients and healthcare providers to consider. If two treatments are equally effective and safe, it may make sense to consider the more affordable option.
Links and Resources:
Watch the interview on the abstract here:
You can read the actual ASH abstract here: Budget impact of fixed duration acalabrutinib in combination with venetoclax in previously untreated chronic lymphocytic leukemia patients in the United States
