Venetoclax in Combination with Obinutuzumab in Previously Untreated Fit Patients with Chronic Lymphocytic Leukemia: A Canadian Cost-Utility Analysis.

Abstract

Background/objective: Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder diagnosed in Canada and is associated with a significant economic burden. This study evaluates the cost effectiveness of fixed-treatment duration venetoclax plus obinutuzumab (VEN + O) for previously untreated, fit CLL patients in Canada, for whom this therapy is not universally reimbursed provincially.

Methods: A three-state partitioned survival model was developed using data from the CLL13 trial and a Bayesian network meta-analysis. Health states included progression-free, progressed disease, and death. A lifetime horizon (40-year) was used and a 1.5% discount rate was applied to costs and effects. Costs included drug acquisition, administration, monitoring, adverse events, subsequent treatment, and terminal care. Utility values were derived from previous NICE technology appraisals in CLL. Extensive sensitivity and scenario analyses were conducted.

Results: VEN + O was associated with lower total costs and higher quality-adjusted life years and thus dominant compared with ibrutinib, zanubrutinib, and fludarabine plus cyclophosphamide plus rituximab. Compared with acalabrutinib and venetoclax plus ibrutinib, the incremental cost-utility ratios (ICURs) were in the south-west quadrant and substantially above a CA$50,000/QALY willingness-to-pay threshold, meaning VEN + O was cost effective versus these comparators. VEN + O was cost effective versus bendamustine plus rituximab. Extensive sensitivity and scenario analyses confirmed the robustness of these results.

Conclusions: This analysis demonstrates that VEN + O, a 12-month fixed duration treatment, is a cost-effective option for previously untreated fit CLL patients in Canada. VEN + O offers potential health benefits and cost savings when compared with relevant comparator treatments.