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Oral targeted therapies will increase survival, cost of CLL
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Although oral targeted therapies are expected to increase survival in patients with chronic lymphocytic leukemia, the cost of medication could impose significant financial burdens on patients and payers, study data show.
Researchers wrote that sustainable pricing for such therapies are necessary to avoid “financial toxicity” for patients as targeted oral therapies become the norm for treating chronic lymphocytic leukemia (CLL).
Significant advances have been made in the treatment of CLL due to a better understanding of its biology.
“In particular, oral targeted agents, such as ibrutinib [Imbruvica; Janssen, Pharmacyclics] and idelalisib [Zydelig, Gilead], have demonstrated remarkable outcomes in patients with CLL. In addition, several other targeted therapies are expected to become available in the near future,” Qiushi Chen, PhD, research assistant at the Georgia Institute of Technology, and colleagues wrote. “However, the high cost of these targeted therapies raises concerns for payers as well as for patients.
“Novel targeted therapies could strain the budget of both private and government payers, such as Medicare, and copayments and other expenses can be a substantial burden to patients, yet the budget impact and cost-effectiveness of these therapies are not well understood,” Chen and colleagues wrote.
Ibrutinib and idelalisib both cost approximately $130,000 per year, compared with $60,000-$100,000 for a typical 6-month cycle of chemoimmunotherapy.
Researchers created a simulation model that reflected changes in CLL care from 2011 to 2025. The model used targeted oral therapies as first-line treatment from 2016 to 2025 and for patients with relapsed disease or del(17p) from 2014 to 2016; chemoimmunotherapy was considered the standard of care from 2011 to 2014. Researchers compared this model to a scenario in which chemoimmunotherapy was the standard of care for the entire study period.
Disease progression and survival data were based on published trials and accounted for the cost of drugs and administration, as well as disease management and routine follow-up.
The researchers predicted the number of patients living with CLL would increase from 128,000 in 2011 to 199,000 in 2025 (55% increase). The cost of disease management, however, was projected to increase dramatically: from $0.74 billion to $5.13 billion (590% increase).
The lifetime per-patient cost of treating CLL would increase 310%, from $147,000 to $604,000 with the rise of oral targeted therapies. Out-of-pocket costs for Medicare patients would increase 520%, rising from $9,200 for those who started therapy in 2014 to $57,000 for those who started in 2016 or later.
Chen and colleagues acknowledged limitations in their study, including not all possible treatments were included and that their model did not account for possible fluctuation in drug prices over time.
“Oral targeted therapies will increase survival rates substantially; however, with the current price structure, they will dramatically increase the cost of CLL management for both patients and payers,” the researchers wrote. “Such an economic impact could result in financial toxicity, limited access and lower adherence to the oral therapies, which may undermine their clinical effectiveness. A more sustainable pricing strategy is needed for oral targeted therapies.” – by Andy Polhamus
Disclosure: Chen reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.
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