OBJECTIVES: To demonstrate the economic advantages of using venetoclax (plus obinutuzumab [VenO] or rituximab [VenR]) vs acalabrutinib monotherapy (Acala) in the first line (1L) and relapse or refractory (R/R) chronic lymphocytic leukemia (CLL) treatment under the Brazilian public healthcare system (SUS).

METHODS: Similar efficacy between VenO, VenR and Acala on Overall Survival and Progression-Free Survival were demonstrated in both lines (1L and R/R respectively) by two network meta-analysis (Molica et al 2021;2020). The same similarity was shown in a head-to-head trial comparing Acala vs ibrutinib (Byrd et al 2021) and by an indirect comparison of VenR vs B-cell receptor inhibitors (Mato et al 2018). Assuming this similar efficacy, was developed a Cost-Minimization Analysis comparing these treatment options taking the drugs acquisition costs and comparing the costs per patient over 4-years. A Budget Impact Analysis (BIA) was developed considering the estimative for the number of high-risk patients to be treated by the Brazilian public healthcare system (3,183 patients/year for 1CLL and 694 patients/year for R/R).

RESULTS: For 1L and R/R-CLL treatments, the 4-years direct costs of treatment show that VenO and VenR results in cost savings up to BRL 2,209,469 (-77%) and BRL 2,241,944.25 (-71%) per patient, respectively, when compared to Acala. These savings tend to be higher the longer the duration of treatment. BIA showed savings of more than 8 billion and 700 million in 5 years, for 1L and R/R-CLL treatments, respectively.

CONCLUSIONS: VenO and VenR have shown evidence of being the only fixed duration treatment regimens that achieve a sustained CLL remission when compared to continuous Acala monotherapy, with similar prices and more convenient treatment for patients and healthcare providers. Therefore, Ven-based regimens imply in cost-savings and benefits in quality of life when compared to Acala, while the clinical outcomes remain favorable.