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Cost Effectiveness of Zanubrutinib Versus Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia

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Abstract

Background

While the efficacy and safety of zanubrutinib have been established in relapsed or refractory chronic lymphocytic leukemia, the evidence on cost effectiveness is still lacking.

Objective

We aimed to evaluate the cost effectiveness of zanubrutinib versus ibrutinib in relapsed or refractory chronic lymphocytic leukemia from the commercial payer perspective in the USA.

Methods

A partitioned survival model was developed based on survival curves from the phase III ALPINE trial. We reconstructed patient-level data for each curve and conducted a parametric estimation to incorporate long-term clinical outcomes and treatment costs into the model. Medical costs and utilities were obtained from public data and previous cost-effectiveness studies. A discount rate of 3.0% per annum was applied and costs were adjusted to 2023 US dollars. The incremental cost-effectiveness ratio was calculated by dividing the incremental costs of zanubrutinib over ibrutinib by the incremental life-years or quality-adjusted life-years. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of the results.

Results

Over a 10-year analysis period, the incremental cost-effectiveness ratio of zanubrutinib versus ibrutinib was $91,260 per life-year gained and $120,634 per quality-adjusted life-year gained, making it cost effective within a threshold of $150,000 per quality-adjusted life-year gained. The incremental cost-effectiveness ratio was most sensitive to drug acquisition costs and progression-free survival distributions, and the probability of zanubrutinib being cost effective was approximately 52.8%, with a 30.0% likelihood of dominance.

Conclusions

Zanubrutinib is likely to be cost effective versus ibrutinib in relapsed or refractory chronic lymphocytic leukemia in the USA, but the high threshold should be noted. Our findings may provide a basis for pricing strategy and reimbursement decisions for zanubrutinib.

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Author notes

  1. Shouhao Zhou and Chan Shen contributed equally to this study.

Authors and Affiliations

  1. Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, 500 University Drive, H151, Hershey, PA, 17033-0850, USA

    Dong-Won Kang & Chan Shen

  2. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

    Li Wang, Shouhao Zhou & Chan Shen

  3. Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Nicholas J. Short & Alessandra Ferrajoli

  4. Department of Hematology, Mayo Clinic College of Medicine, Rochester, MI, USA

    Yucai Wang

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Correspondence to Chan Shen.

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Conflicts of interest/competing interests

Dong-Won Kang, Li Wang, Nicholas J. Short, Alessandra Ferrajoli, Yucai Wang, Shouhao Zhou, and Chan Shen have no conflicts of interest that are directly relevant to the content of this article.

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Availability of data and material

The ALPINE trial data were obtained from the original article: Brown et al. [8]. Other input data were obtained from original articles and publicly available data. The data are available upon reasonable request.

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Authors’ contributions

CS and SZ developed the concept and design of the study. D-WK developed the model and collected and analyzed the data. All authors interpreted the data. D-WK and CS wrote the first draft. All authors contributed to the critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript. CS and SZ supervised the study.

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Kang, DW., Wang, L., Short, N.J. et al. Cost Effectiveness of Zanubrutinib Versus Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia. PharmacoEconomics 42, 409–418 (2024). https://doi.org/10.1007/s40273-023-01346-8

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