Journal Logo

Online Only

Stay current on oncology news and trends with exclusive online content.

Tuesday, June 2, 2020

Understanding the Implication of Sequencing on HRU/Cost for CLL/ SLL Patients

​By Sarah LaCorte

A retrospective study evaluated health care resource utilization (HRU)/costs associated with venetoclax treatment in various sequencing scenarios, including prior use of ibrutinib for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). The results were presented at the ASCO 2020 Annual Meeting (Abstract e19354).

Since it was approved by the FDA in March 2016, ibrutinib has become an established standard of care for CLL/SLL patients across all lines irrespective of patient age, comorbidities, and risk status. When the FDA approved venetoclax in May 2019, researchers found a need to understand the real-world treatment sequencing of targeted oral agents, and the implication of sequencing on HRU/costs.

In the study presented at ASCO 2020, Kerry Anne Rogers, MD, a hematologist-oncologist at the Ohio state Comprehensive Cancer Center, and co-authors identified adults with CLL/SLL with venetoclax with Optum Clinformatics Extended Data Mart De-Identified Databases between April 11, 2015, through June 30, 2019. They excluded investigational combination therapies.

The index date was the start of the first venetoclax-based line of therapy (index LOT) and the baseline period was the 12-month period pre-index. Mean all-cause HRU/costs per patient per month (PPPM) were calculated during the index LOT and the venetoclax ramp-up period, defined as the first 30 days post-index.

The study included 11,861 CLL/SLL patients who received ≥1 LOT: 121 patients (1.0%) were treated with venetoclax, including 25 patients (64.0% single agent) using venetoclax in first line (1L cohort), 30 (90.0% single agent) in second line (2L cohort), and 66 (83.3% single agent) in third line or later (3L+ cohort). The mean age was 71.6 years and 33.1 percent of patients were female. The mean baseline Quan-Charlson Comorbidity Index score was 4.7 and median follow-up from the start of 1L was 25.3 months. Median duration of index LOT was 4.2 months.

The majority of 2L+ venetoclax patients were previously treated with ibrutinib (2L: 56.7%, 3L+: 74.2%). Patients in all 3 cohorts had frequent outpatient (OP) visits PPPM during their index LOT (1L: 4.58; 2L: 4.75; 3L+: 5.71). Total costs PPPM during the index LOT were highest in the 1L cohort (1L: $21,762; 2L: $17,697; 3L+: $20,900), driven by higher OP costs (1L $9,402; 2L: $5,633; 3L+: $7,701). Increased total costs PPPM were observed during venetoclax ramp-up (1L: $31,707; 2L: $21,036; 3L+: $25,362). Compared to the overall 2L cohort, those treated with ibrutinib in 1L had lower total costs PPPM (index LOT: $15,350; V ramp-up: $15,882).

"The study provides valuable insights as we further explore the combination and sequencing of novel agents with complementary mechanisms of actions in CLL, such as ibrutinib and venetoclax. While this is a descriptive study, we found that the results reinforce our hypothesis and suggest that previous treatment with ibrutinib may help to reduce costs in subsequent treatment with venetoclax," said Qing Huang, PhD, MHS, second author on the study and Director, Real-World Value & Evidence, Oncology, Janssen Oncology. 

The authors concluded that the highest costs PPPM were observed for venetoclax treatment in the 1L. Prior treatment with ibrutinib was common among 2L and 3L+ CLL/SLL patients treated with venetoclax. Importantly, the study revealed that among 2L venetoclax patients, those previously treated with ibrutinib in 1L had $2,347 and $5,154 lower costs PPPM during 2L and venetoclax ramp-up, respectively, suggesting that previous ibrutinib treatment may help reduce costs in subsequent treatment.

Sarah LaCorte is associate editor.