Ibrutinib versus bendamustine plus rituximab for first-line treatment of older patients with untreated chronic lymphocytic leukemia without del(17p)/TP53 mutation in China: A lifetime economic research study

Abstract

Abstract Background The incidence and mortality rates of patients with chronic lymphocytic leukemia (CLL) in China have recently increased. This study performed a long-term economic evaluation of the first-line treatment strategies ibrutinib (IB) or bendamustine (BE) plus rituximab (RI) for previously untreated older patients with CLL without the del(17p)/TP53 mutation in China. Methods Based on clinical data from large, randomized trials, a Markov model including four disease states (event-free survival, treatment failure, post-treatment failure, and death) was used to estimate the incremental costs per quality adjusted-life year (QALY) gained from the first-line IB strategy versus the BE plus RI strategy over a 10-year period. All costs were adjusted to 2021 values based on the Chinese Consumer Price Index, and all costs and health outcomes were discounted at an annual rate of 5%. Sensitivity analysis was performed to confirm the robustness of base-case results. Results Compared to the first-line BE plus RI strategy, first-line IB treatment achieved 1.17 additional QALYs, but was accompanied by $90,843.67 (estimated in 2021 US dollars) in decremental costs per patient over 10 years. Thus, first-line treatment with IB appeared to have absolute dominance compared to the BE plus RI strategy. Sensitivity analysis confirmed the robustness of these results. Conclusions From the perspective of the Chinese health care system, first-line treatment with IB is absolutely cost-effective compared to the first-line BE plus RI strategy for the treatment of older patients with CLL without the del (17p)/TP53 mutation. Therefore, we strongly recommend that Chinese health authorities select the former strategy for these CLL patients.