Comparing time to next treatment, health care resource utilization and costs between patients with chronic lymphocytic treated with ibrutinib or chemoimmunotherapy

This study aimed to compare health care costs, resource utilization and time to the next treatment in patients with chronic lymphocytic leukemia who received ibrutinib or chemoimmunotherapy. 

This study concluded that ibrutinib in these patients was associated with lower medical costs and longer time to next treatment when compared to patients who received chemoimmunotherapy. 

Ibrutinib (Ibmruvica) is a targeted therapy used in chronic lymphocytic leukemia (CLL). Chemoimmunotherapy (CIT) combines chemotherapy and immunotherapy. It works by killing cancer cells and restoring the ability of the immune system. One common CIT regimen includes the combination of bendamustine (Treanda) and rituximab (Rituxan).

Studies have been carried out to assess ibrutinib's economic burden versus CIT but these studies focused on pharmacy costs and not medical costs. It was unknown if the time to next treatment (TTNT), health care resource utilization (HRU) and total direct costs for patients with CLL differed if they received ibrutinib or CIT. 

This study involved 1161 patients with CML. 322 patients received ibrutinib as initial treatment. 839 patients received treatment of initiation treatment of CIT. A sub-group of CIT patients received bendamustine/rituximab (BR) as initial treatment. Fludarabine (Fludara), cyclophosphamide (Cytoxan), and rituximab combination (FCR) was another CIT regimen used. Patients were followed up for an average of 12.9-13.1 months.

TTNT was significantly longer for the ibrutinib group compared to the CIT group. Ibrutinib-treated patients were 46% less likely to require another treatment after 24 months compared to the CIT group. The ibrutinib group was 25% less likely to have monthly days with outpatient visits when compared to the CIT group during entire front-line therapy. 

The ibrutinib group had higher pharmacy costs offset by lower medical costs compared to the CIT group. This led to significant savings compared to the CIT group. Cost savings and reductions in HRU were more significant during the first 6 months of front-line therapy.  

This study concluded that during front-line CLL treatment, ibrutinib was associated with a longer time to next treatment, fewer monthly days with outpatient visits, and net monthly total cost reduction when compared to CIT. 

This study was based on medical records. Information might have been missing. Further studies are needed.