Economic impact of sequencing treatments with oral therapies for chronic lymphocytic leukemia in Spain

Introduction: Chronic lymphocytic leukemia represents a burden for the Spanish National Health System (NHS). Objective: This study estimated the total cumulative costs per patient over 10 years of different treatment sequences with oral therapies for adults with chronic lymphocytic leukemia financed by the Spanish NHS. Method: We conducted a survival model, which included up to 3 lines of therapy. Patients were categorized into 4 alternative states: first-, second-, third-line therapies, and death. Each state distribution was determined based on data from clinical trials. The treatment sequences including oral chronic lymphocytic leukemia therapies most widely used in clinical practice in Spain, were included. Only direct costs were contemplated. The study analyzed 2 population scenarios: patients with and without deletion in 17p [del(17p)]. Results: In the del(17p) scenario, a mean total cost of all sequences was estimated at € 589,685.67 (€ 411,826.29 for the sequences starting with venetoclax + obinutuzumab and € 678,615.36 for the remaining sequences). For the scenario without del(17p), a mean cost of all sequences was estimated at € 556,115.80 (€ 269,148.58 for those starting with venetoclax + obinutuzumab and € 670,902.69 for the rest). Conclusions: Starting first-line therapy with venetoclax + obinutuzumab, regardless of del(17p), would mean estimated savings for the Spanish NHS between € 265,000 and € 405,000 per patient.