OBJECTIVES: Ponatinib and asciminib are the only two tyrosine kinase inhibitors (TKIs) approved in the United States (US) for the treatment T315I-positive chronic phase chronic myeloid leukemia (CP-CML) with resistance or intolerance to at least two prior TKIs. The objective was to assess the treatment-related costs of ponatinib and asciminib in the above-mentioned indication over a time horizon of three years from US Commercial and Medicare payer perspectives.

METHODS: A cost of treatment calculator was developed to determine the drug acquisition, monitoring, and adverse events (AE) management costs (based on grade 3/4 AEs occurring in >=2% of patients) with ponatinib and asciminib over the course of treatment. The median treatment duration of each therapy was used to determine the percentage of patients who remained on treatment over time, assuming an exponential distribution. Ponatinib’s median treatment duration (140.5 weeks) and incidence of AEs were obtained using individual patient data from the PACE trial (NCT01207440); monitoring health care resource use (HCRU) was from ponatinib’s prescribing information (PI). Asciminib’s inputs were from its PI (median treatment duration 108 weeks). Wholesale acquisition costs were from the RedBook. Monitoring and AE management costs were from public databases including the Healthcare Cost and Utilization Project data by diagnosis-related group, and Medicare Clinical Diagnostic Laboratory, Physician, and Acute Inpatient Prospective Payment System Fee Schedules. Costs were inflated to 2023 as needed.

RESULTS: From the Commercial perspective, the total treatment-related costs over three years were $498,209 for ponatinib and $2,332,319 for asciminib. Drug acquisition costs were the main contributor: $480,755 and $2,327,904 for ponatinib and asciminib, respectively. Results were consistent from the Medicare perspective.

CONCLUSIONS: This analysis demonstrates that the total treatment-related costs over the course of therapy for patients with T315I-positive CP-CML are nearly five-fold lower with ponatinib versus asciminib from the payer perspective in the US.