OBJECTIVES:

New medication for chronic lymphocytic leukemia (CLL) have been launched the last few years, such as oral targeted therapies and new generation anti-CD20 monoclonal antibodies, notably obinutuzumab (2016) and acalabrutinib (2020). The aim of this study is to analyse the impact of these therapies on expenditure and consumption for hospital and ambulatory sector.

METHODS:

The European Medicines Agency's Summaries of Product Characteristics were used to identify medicines indicated in CLL. Expenditure and consumption in defined daily doses (DDD)* were extracted over 5 years (2017-2021) from the Paris University Hospital (AP-HP) database and the French national health insurance (Ameli) outpatient database.

RESULTS:

Between 2017 and 2021, eleven drugs were used at AP-HP in treatment for CLL. Among them, bendamustine, alemtuzumab, chlorambucil, cyclophosphamide, fludarabine, obinutuzumab, rituximab, and idelalisib are administered only to inpatients. Acalabrutinib is available for outpatient in hospital pharmacies; ibrutinib and venetoclax are delivered in community pharmacies. Hospital drugs expenditures have dropped from €12M to €2M in 5 years (that is 191K DDD to 51K DDD), except for obinutuzumab (€170K to €311K). Conversely, ambulatory consumption have increased between 2017 and 2021: from €1.3M to €41M or 7K to 229K DDD (community pharmacies), and from €19K in 2020 to €2M 2021 for acalabrutinib.

CONCLUSIONS:

The management of CLL gradually shifts from hospital to outpatient care. Consequently, the ambulatory care money envelop has been significantly affected more than the hospital budget because of these new medicines.

*from World Health Organisation (WHO)