, Volume 34, Issue 5, pp 479–498 | Cite as

Economic Burden and Quality-of-Life Effects of Chronic Lymphocytic Leukemia: A Systematic Review of the Literature

  • Simon Frey
  • Carl R. Blankart
  • Tom StargardtEmail author
Systematic Review



Chronic lymphocytic leukemia (CLL) is the most prevalent type of leukemia in the Western hemisphere. The disease affects quality of life (QOL) and poses an economic burden on patients, payers, and society. The objective of this review was to quantify the economic burden and quality-of-life effects and identify the gaps that should be addressed by future research.


Free-text and subject heading searches in MEDLINE, EMBASE, the Cochrane Library, the University of York Centre for Reviews and Dissemination Database, and the Web of Science Core Collection database were conducted to identify observational and interventional studies reporting costs and/or quality-of-life effects published up to 2 October 2015. Studies were included irrespective of whether they were conducted prospectively or retrospectively. The focus population consisted of adult patients aged 18 years or older affected by any stage of CLL. Studies were included regardless of whether the underlying population was treated at baseline or not. Risk of bias was assessed using a quality checklist developed by the Effective Public Health Practice Project for (randomized) controlled trials, cohort studies, and cross-sectional studies. Economic evaluations were rated using a checklist developed by Stuhldreher et al. (Int J Eat Disord 45:476–91, 2012).


From 2451 records identified, 27 studies were found to be eligible for inclusion. Studies were heterogeneous with respect to methodology, perspective, and data used. Annual direct costs per person ranged from US$4491 in Germany to US$43,913 in the USA. The share of costs attributable to drug treatment varied between 26.2 and 79 %. Indirect costs amounted to US$4208. Severity of disease was a predictor for quality of life, whereas differences by age and sex were mainly present in subdomains. Comparisons of treated and untreated populations resulted in an increase of quality of life in favor of treated populations in the long-term perspective. Differences between treatments were small. Consequently, cost effectiveness in decision–analytic models did not depend on whether quality of life or survival are used to describe the benefits of treatment.


Although the quantity and the quality of health economic and quality-of-life evidence have substantially increased, there is still a need for studies that take a patient or societal perspective. Factors that influence costs and the quality of life of patients seem to be well-established, while longitudinal lifetime cost studies at the population level are still scarce.


Chronic Lymphocytic Leukemia Alemtuzumab Chlorambucil Bendamustine Chronic Lymphocytic Leukemia Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.




Compliance with Ethical Standards

SF, CRB, and TS did not receive specific funding for this study. SF, CRB, and TS declare that they have no conflicting interests, commercial, personal, political, intellectual or otherwise, relating to this manuscript.

Funding disclosure

No relevant financial relationship exists.

Authors’ contributions

SF, CRB, and TS designed the study, carried out the methodological framework, collected the data, and reviewed the studies. SF, CRB, and TS contributed to the writing, interpretation of the results, and revision of the manuscript.

Supplementary material

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Supplementary material 1 (XLSX 12 kb)
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Supplementary material 2 (XLSX 15 kb)
40273_2015_367_MOESM3_ESM.docx (11 kb)
Supplementary material 3 (DOCX 11 kb)


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
  2. 2.Center for Gerontology and Health Care Research, School of Public HealthBrown UniversityProvidenceUSA

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