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Ibrutinib (Imbruvica) may be a cost-effective option compared with chemoimmunotherapy for front-line treatment in chronic lymphocytic leukemia (CLL), particularly for complying with an Oncology Care Model (OCM) quality metric, according to a study presented at the 2018 AMCP Nexus (October 22-25, 2018; Orlando, FL).

The OCM requires participating practices to deliver quality, coordinated care and evaluate financial performance over a 6-month episode after initiating oncology treatment. Currently, ibrutinib is the only FDA-approved front-line B-cell receptor inhibitor therapy for CLL, and an assessment of real-world health care resource utilization and costs during front-line OCM episodes with ibrutinib vs chemoimmunotherapy is warranted.

Anthony Mato, MD, Memorial Sloan Kettering Cancer Center (New York, NY), and colleagues designed an analysis to compare health resource utilization and costs between patients with CLL receiving ibrutinib or chemoimmunotherapy during first-line OCM episodes. A total of 322 patients who initiated single-agent ibrutinib and 839 patients who initiated chemoimmunotherapy on or after February 12, 2014 were identified from the Optum Clinformatics Extended DataMart De-Identified Databases. Patients had at least two CLL claims.

Weighted generalized linear models were used to compared health resource utilization and costs during first-line OCM episodes.

Results of the analysis showed that patients in the ibrutinib cohort had significantly fewer days with outpatient (rate ratio, 0.60; P < .0001) and ER visits (rate ratio, 0.55; P = .032) compared with patients in the chemoimmunotherapy cohort. Higher pharmacy costs (mean monthly cost difference, $7299; P < .0001) in the ibrutinib cohort were offset by lower medical costs (-$15,664; P < .0001), which yielded a net monthly savings of $8365 (P < .0001) compared with the chemoimmunotherapy cohort.

Ibrutinib was also compared with a subgroup of chemoimmunotherapy patients who initiated treatment with bendamustine plus rituximab (n = 455). Relative to these patients, those who received ibrutinib had fewer days with outpatient (rate ratio, 0.59; P < .0001) and ER visits (rate ratio, 0.53; P = .012). Higher pharmacy costs (mean monthly cost difference, $7381) of ibrutinib were offset by lower medical costs (mean monthly cost difference, -$18,277), which resulted in net monthly cost savings of $10,896 (P < .0001).

Similar results were observed in a sensitivity analysis of the total duration of first-line ibrutinib used to treat disease progression, Dr Mato and colleagues noted.

“Ibrutinib may be a cost-effective mean of complying with the OCM aim to increase the value of health care delivered to patients,” authors of the study concluded.

Zachary Bessette

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