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Jennifer R. Brown, MD, PhD


Cost Considerations of Beginning Treatment of CLL With Venetoclax Plus Obinutuzumab

By: Celeste L. Dixon
Posted: Tuesday, February 21, 2023

The 10-year cumulative costs of treating a newly diagnosed patient with chronic lymphocytic leukemia (CLL) appear to be considerably lower when treatment begins with a 12-month, fixed-duration course of venetoclax combined with obinutuzumab, compared with sequences that begin with other first-line agents that are not of fixed duration (such as ibrutinib or acalabrutinib), according to study results presented during the Journal of the Advanced Practitioner in Oncology conference JADPRO Live (Abstract JL1035E). Mazyar Shadman, MD, MPH, of Fred Hutchinson Cancer Research Center, Seattle, and colleagues aimed to estimate these costs per patient, from a payer perspective, in the course of different treatments.

The work used a partitioned survival model and considered that patients could experience five states in the course of their illness: first-, second-, and third-line treatments; supportive care; and death. These states were “based on efficacy data from clinical trials and real-world data,” explained the team. “Cost components included treatment and administration, monitoring, terminal care, tumor-lysis syndrome prophylaxis ([for] venetoclax-based therapies), and adverse events.” A total of 249 possible treatment sequences were assessed.

Among adults with 17p deletion, the cumulative costs per patient of sequences starting with venetoclax plus obinutuzumab ranged from $935,781 to $1,345,96; comparable costs for patients beginning with ibrutinib- or acalabrutinib-based sequences ranged from $1,426,924 to $1,906,544. Among adults without 17p deletion, the analogous cumulative costs were from $690,346 to $951,633 for venetoclax plus obinutuzumab and from $1,720,745 to $1,976,767 for ibrutinib or acalabrutinib.

“Additionally, retreatment with a venetoclax-based regimen in the second or third line often resulted in sequences with the lowest cost,” noted Dr. Shadman and co-investigators. “Total budget impact of introducing sequences with venetoclax/obinutuzumab in the first line led to [a calculated] cost savings of $12.5 million over 5 years for a health plan of 1 million U.S. members.”

Disclosure: For full disclosures of the study authors, visit

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