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Short Report
23 June 2025

Cost impact of Bruton’s tyrosine kinase inhibitor selection in Medicare patients with chronic lymphocytic leukemia

Authors: Adam S Kittai [email protected], Dipen A Patel, Jason Shafrin https://orcid.org/0000-0001-8444-5979, Nadine Zawadzki, Vikram S Shetty, Yazan K Barqawi, and Joanna M RhodesAuthor Info & Affiliations
Volume 14, Number 8
https://doi.org/10.57264/cer-2025-0035
PDFFormats

Abstract

Aim: To estimate cost savings associated with covalent Bruton’s tyrosine kinase inhibitor (cBTKi) choice in patients with treatment-naive (TN) and relapsed/refractory (RR) chronic lymphocytic leukemia (CLL) from a Medicare perspective. Materials & methods: An economic model with Markov structure simulated outcomes in patients with CLL initiating ibrutinib, acalabrutinib or zanubrutinib monotherapy. Modeled population included TN and RR patients who had no prior cBTKi. Treatments were dosed per US FDA label and efficacy assumed identical across cBTKis. Cumulative grade ≥3 adverse event (AE) rates were drawn from extended follow-up of cBTKi phase III clinical trials at similar duration. Costs included drug price per 2024 wholesale acquisition cost and AE management medical costs from literature, adjusted for Medicare reimbursement. Outcomes were total change in payer cost over 1, 3 and 5 years. Results: A cohort of 13,726 patients with CLL was modeled (44% TN, 56% RR). Acalabrutinib’s aggregate grade ≥3 AE rate was 25.8% points less in TN patients (35.8% vs 61.6%) and 8.0% points less in RR patients (75.0% vs 83.0%) compared with ibrutinib, and 20.6% points less in TN patients (35.8% vs 56.4%) and 11.1% points less in RR patients (75.0% vs 86.1%) compared with zanubrutinib. Acalabrutinib saved $15,478 more per patient versus ibrutinib in year 1 due to lower treatment cost (-$12,076) and lower AE cost (-$3402). Acalabrutinib also saved $1901 more per patient versus zanubrutinib as acalabrutinib higher treatment cost (+$1663) was offset by lower AE cost (-$3563). Across all patients, acalabrutinib saved $212 million more versus ibrutinib and $26 million more versus zanubrutinib from a Medicare perspective. Acalabrutinib cost savings persisted over 3 and 5 years. Conclusion: Acalabrutinib yielded cost savings versus ibrutinib and zanubrutinib for patients with CLL in Medicare due to lower treatment cost versus ibrutinib and fewer grade ≥3 AEs versus both ibrutinib and zanubrutinib.

Plain language summary: Impact of Bruton’s tyrosine kinase inhibitor treatment choice on Medicare cost

What was the study aim?

To estimate cost impact to Medicare from the choice of covalent Bruton’s tyrosine kinase inhibitor (cBTKi) for the treatment of patients with chronic lymphocytic leukemia (CLL).

How was the study carried out?

An economic model was built to estimate costs for patients with CLL (both in the treatment-naive and relapsed setting) covered by Medicare who are starting treatment with ibrutinib, acalabrutinib, or zanubrutinib at recommended doses per their US FDA approved drug labels. The rates of severe side effects experienced with each treatment were taken from long-term reports of their major clinical trials. Costs included drug costs and medical costs of managing the severe side effects. Outcomes were total change in cost over 1, 3 and 5 years after starting treatment.

What were the results?

Acalabrutinib saved $15,478 more per patient versus ibrutinib in the first year due to lower treatment cost (-$12,076) and lower toxicity cost (-$3402). Acalabrutinib also saved $1901 more per patient versus zanubrutinib, as higher treatment cost (+$1663) was offset by lower toxicity cost (-$3563). Cost savings with acalabrutinib persisted over 3 and 5 years.

What do the results mean?

Acalabrutinib showed greater cost savings compared with ibrutinib and zanubrutinib in patients with CLL in Medicare due to lower treatment cost than ibrutinib and less toxicity than both ibrutinib and zanubrutinib.

Supplementary Material

File (supplementary materials.docx)

References

Papers of special note have been highlighted as: • of interest
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