Projected Financial Burden of Targeted Therapies for Chronic Lymphocytic Leukemia
In an analysis reported in the Journal of Clinical Oncology, Chen et al predicted that an increase in the number of patients living with chronic lymphocytic leukemia (CLL) due to improved treatment with oral targeted therapies will be accompanied by a markedly increased overall cost to patients and payers in the United States.
The study involved a simulation model that assessed the changing management of CLL from 2011 to 2025, with chemoimmunotherapy as the standard of care before 2014 and oral targeted therapies for disease with del(17p) and relapsed CLL from 2014 and for first-line treatment from 2016 onward. A comparator model assumed that chemoimmunotherapy remained the standard of care throughout the projected period. Disease progression and survival parameters for the type of therapy were derived from published clinical trials.
Key Study Findings
A projected 55% increase in the number of patients living with CLL from 128,000 in 2011 to 199,000 by 2025 due to improved survival with targeted therapy was accompanied by a 590% increase in the annual cost of CLL management from $0.74 billion to $5.13 billion. The per-patient lifetime cost of treatment was projected to increase by 310% from $147,000 to $604,000, as oral targeted therapies become first-line treatment. Assuming these changes occur, the corresponding total out-of-pocket cost for Medicare patients would increase from $9,200 to $57,000 (an increase of 520%).
Compared with the chemoimmunotherapy scenario, the oral targeted therapy model was associated with an incremental cost-effectiveness ratio of $189,000/quality-adjusted life-year at current prices, exceeding a generally accepted willingness-to-pay threshold of $100,000/ quality-adjusted life-year.
The investigators concluded: “The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients.”
Jagpreet Chhatwal, PhD, of Massachusetts General Hospital Institute for Technology Assessment, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
