Real-World Study Evaluating Drug Tolerability and Health Care Resource Use (HCRU) With Acalabrutinib vs Ibrutinib in Patients With Relapsed/Refractory (R/R) Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)
Author(s)
Daniel Ermann, MD1, George Dranitsaris, PhD2, Sibel Blau, MD2, Aaron Peevyhouse, MBA2, Heather Neuhalfen, MBA2, Vikram Shetty, MD3, Dipen Patel, PhD3, Samantha L. Thompson, PhD4, Anna Teschemaker, PhD3, Mayur Narkhede, MD5;
1University of Utah, Salt Lake City, UT, USA, 2ONCare Alliance, Tacoma, WA, USA, 3AstraZeneca, Gaithersburg, MD, USA, 4AstraZeneca, Cambridge, United Kingdom, 5The University of Alabama at Birmingham, Birmingham, AL, USA
1University of Utah, Salt Lake City, UT, USA, 2ONCare Alliance, Tacoma, WA, USA, 3AstraZeneca, Gaithersburg, MD, USA, 4AstraZeneca, Cambridge, United Kingdom, 5The University of Alabama at Birmingham, Birmingham, AL, USA
OBJECTIVES: Bruton tyrosine kinase inhibitors, acalabrutinib and ibrutinib, are standard of care in CLL/SLL but associated cardiovascular toxicities may increase HCRU. This study compared the tolerability, cardiovascular adverse events of interest, and HCRU between acalabrutinib and ibrutinib monotherapy in R/R CLL/SLL in the USA.
METHODS: A large retrospective study was conducted using electronic medical record data from the ONCare Alliance Network, an alliance of 32 community practices. Data were analyzed from R/R patients receiving acalabrutinib or ibrutinib from 1/1/2017 to 12/31/2023. Data collected included patient and disease characteristics, medical events of interest (MEOI), tolerability (i.e. discontinuation due to MEOI), and HCRU, consisting of clinic visits, emergency department (ED) visits, hospital admissions, specialist consultations, and medical interventions. The primary endpoint, hypertension, was evaluated using propensity score weighted multivariate logistic regression analysis.
RESULTS: 270 patients (acalabrutinib: 90; ibrutinib: 180) were included. The acalabrutinib group was slightly older than the ibrutinib group (median age: 74.5 vs 70.0 years) and had a similar ECOG performance status (≥2: 7.8% vs 8.3%). After a median follow-up of 33 months, fewer MEOI occurred with acalabrutinib than ibrutinib (23.3% vs 36.7%; p=0.027), including hypertension (5.6% vs 13.9%), atrial fibrillation (7.8% vs 13.9%), and bleeding events (7.8% vs 11.7%). Discontinuation due to MEOI was 20.0% with acalabrutinib and 38.9% with ibrutinib. Hospital admissions for MEOI were lower with acalabrutinib than ibrutinib (0.20 vs 0.24 per patient), as was the median length of hospitalization (3 vs 6 days per admission). There were also fewer specialist consultations (0.11 vs 0.22 per patient) and medical interventions (0.11 vs 0.18 per patient) with acalabrutinib than ibrutinib.
CONCLUSIONS: In R/R CLL/SLL, acalabrutinib showed better tolerability than ibrutinib, with lower rates of treatment discontinuation and MEOI, and reduced HCRU, which may translate to a lower economic burden with acalabrutinib in CLL/SLL.
METHODS: A large retrospective study was conducted using electronic medical record data from the ONCare Alliance Network, an alliance of 32 community practices. Data were analyzed from R/R patients receiving acalabrutinib or ibrutinib from 1/1/2017 to 12/31/2023. Data collected included patient and disease characteristics, medical events of interest (MEOI), tolerability (i.e. discontinuation due to MEOI), and HCRU, consisting of clinic visits, emergency department (ED) visits, hospital admissions, specialist consultations, and medical interventions. The primary endpoint, hypertension, was evaluated using propensity score weighted multivariate logistic regression analysis.
RESULTS: 270 patients (acalabrutinib: 90; ibrutinib: 180) were included. The acalabrutinib group was slightly older than the ibrutinib group (median age: 74.5 vs 70.0 years) and had a similar ECOG performance status (≥2: 7.8% vs 8.3%). After a median follow-up of 33 months, fewer MEOI occurred with acalabrutinib than ibrutinib (23.3% vs 36.7%; p=0.027), including hypertension (5.6% vs 13.9%), atrial fibrillation (7.8% vs 13.9%), and bleeding events (7.8% vs 11.7%). Discontinuation due to MEOI was 20.0% with acalabrutinib and 38.9% with ibrutinib. Hospital admissions for MEOI were lower with acalabrutinib than ibrutinib (0.20 vs 0.24 per patient), as was the median length of hospitalization (3 vs 6 days per admission). There were also fewer specialist consultations (0.11 vs 0.22 per patient) and medical interventions (0.11 vs 0.18 per patient) with acalabrutinib than ibrutinib.
CONCLUSIONS: In R/R CLL/SLL, acalabrutinib showed better tolerability than ibrutinib, with lower rates of treatment discontinuation and MEOI, and reduced HCRU, which may translate to a lower economic burden with acalabrutinib in CLL/SLL.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE35
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology