(137) Lower total cost of care of first-line fixed-duration venetoclax + obinutuzumab vs treat-to-progression Bruton’s tyrosine kinase inhibitor regimens in patients with chronic lymphocytic leukemia in the United States: a population-based model

Background: : Venetoclax + obinutuzumab (VenO), the only United States (US) FDA-approved B-cell lymphoma 2 inhibitor fixed-duration treatment (FDT), has demonstrated cost savings over 3 years (yrs) vs Bruton’s tyrosine kinase inhibitor (BTKi) treat-to-progression (TTP) regimens in previous economic models. The broader, longer-term population-level impact is not well established.

Objective: : To estimate the annual total cost of care (TCC) in the US for treating chronic lymphocytic leukemia (CLL) with first-line FDT VenO vs TTP BTKi regimens among all adults and a subset of Medicare-eligible adults.

Methods: : A US population model was developed to calculate the TCC for previously untreated CLL across all adults (≥18 yrs) and a subset of Medicare-eligible adults (≥65 yrs) over 10 yrs (2019–2028). The model compared a hypothetical all-VenO-treated (assumed duration of 1 yr) vs an all-BTKi-treated (ibrutinib ± rituximab/obinutuzumab or acalabrutinib ± obinutuzumab) population. Patient cohorts entered annually and were followed for 3 and 5 yrs. CLL incidence rates were sourced from the Surveillance, Epidemiology, and End Results Program and applied to a population from the US census. Per-patient yearly costs by treatment were derived from a published TCC model, incorporating treatment, adverse event management, routine care, and monitoring costs. Drug costs used average wholesale acquisition costs from Truven Health Analytics Red Book® (2019–2024); post-2024 prices were projected based on historic trends.

Results: : In 2019, the estimated management cost of previously untreated CLL in the US was $1.93 billion (B) and $1.94B (Medicare subset: $1.41B and $1.42B) for hypothetical all-VenO-treated and all-BTKi-treated populations, respectively. By 2028, the estimated cost for an all-VenO-treated and all-BTKi-treated population was $3.78B vs $7.10B (Medicare subset: $2.73B vs $3.72B) with a 3-yr follow-up, and $4.53B vs $11.55B (Medicare subset: $3.28B vs $6.05B) with a 5-yr follow-up, respectively. Over 10 yrs, an all-BTKi-treated population would incur an extra $26.0B (Medicare subset: $15.6B) vs an all-VenO-treated population with a 3-yr follow-up, and an additional $48.1B (Medicare subset: $29.8B) with a 5-yr follow-up, primarily due to continued drug costs.

Conclusions: : Over 10 yrs, a hypothetical all-VenO-treated population could save the US up to $48.1B vs an all-BTKi-treated population for previously untreated CLL. Of this, $29.8B is attributed to savings among Medicare-eligible patients. Despite rising overall CLL costs, FDT regimens resulted in substantial cost savings vs TTP regimens.

Sponsorship:: Genentech, Inc., AbbVie Inc.