A Probabilistic Cost-Effectiveness Analysis of Venetoclax and Obinutuzumab As a First-Line, 12-Month, Fixed Duration Therapy in Chronic Lymphocytic Leukemia (CLL) in Canada
Author(s)
Chatterjee A1, van de Wetering G2, Goeree R3, Owen C4, Barakat S5, Manzoor B6, Sail K7
1OPEN Health, York, UK, 2OPEN Health, Rotterdam, Netherlands, 3Goeree Consulting Ltd., Mount Hope, ON, Canada, 4Foothills Medical Centre, Calgary, AB, Canada, 5AbbVie Corporation, Saint-Laurent, QC, Canada, 6AbbVie Inc., CHICAGO, IL, USA, 7AbbVie Inc., North Chicago, IL, USA
Presentation Documents
Objectives: To assess the cost effectiveness of venetoclax + obinutuzumab (VENCLAXTA® + GAZYVA®), (Ven+O) for the frontline treatment of CLL (1L CLL) in Canada from a publicly funded healthcare system perspective. Methods: A partitioned survival analyses (PartSA) model was developed with three health states: progression free, progressed, and death. A cycle length of 28 days and a time horizon of 10 years was used for the model. VEN+O treatment for a fixed duration of 12 months was compared to G + Chlorambucil (GClb), Fludarabine plus Cyclophosphamide plus Rituximab (FCR), Bendamustine plus Rituximab (BR), Chlorambucil plus Rituximab (Clb+R), Ibrutinib (Ibr) and Acalabrutinib. The population in the model included both unfit and overall 1L CLL patients, two subgroups were also assessed (patients with del17p/TP53 mutations and patients without del17p/TP53 mutations). Survival data extrapolated from the CLL14 trial were used to populate the model. Uncertainty was assessed via one-way sensitivity analyses, probabilistic analyses (PA), and scenario analyses. Results: Based on the PA, unfit 1L CLL patients receiving VEN+O were estimated to incur costs of $217,727 [confidence interval (CI): $170,725, $300,761] (Del(17p)/TP53: $209,102 [CI: $159,698, $386,190], Non-Del(17p)/TP53: $217,732 [CI: $171,232, $299,063]) and accrue 4.96 [CI: 4.04, 5.82] quality-adjusted-life-years (QALYs) (Del(17p)/TP53: 3.11 [CI: 2.00, 4.20], Non-Del(17p)/TP53: 5.04 [CI: 4.05, 5.92]). GClb, BR, Clb+R, and Ibr accrued less QALYs and higher costs, VEN+O was the dominant treatment option. Acalabrutinib showed higher QALY gain and substantially higher costs compared to VEN+O, leading to an incremental-cost-effectiveness-ratio (ICER) of $2,139,180/QALY gained and therefore not a cost-effective option. PA shows that at a willingness-to-pay of $50,000/QALY gained, VEN+G has 98% probability of being cost-effective. Conclusion: VEN+G is a cost-effective treatment option for unfit 1L CLL patients and provides excellent value to the healthcare system in Canada.
Conference/Value in Health Info
2022-05, ISPOR 2022, Washington, DC, USA
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
EE12
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology