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Research Article
14 October 2025

Healthcare cost comparison between first-line ibrutinib and acalabrutinib in chronic lymphocytic leukemia patients in the Veterans Affairs

Authors: Lindsey Fitzgerald https://orcid.org/0000-0001-5988-2878, Sabyasachi Ghosh, Alex Bokun https://orcid.org/0000-0002-2622-6513, Angela Lax https://orcid.org/0000-0001-9577-8904, Fan Mu, Eric Wu, Yilu Lin https://orcid.org/0000-0001-7040-4287, Lizheng Shi https://orcid.org/0000-0002-7827-6766, Zaina P Qureshi https://orcid.org/0000-0001-9605-3980 [email protected], and Solomon A Graf https://orcid.org/0000-0002-9475-3016Author Info & Affiliations
Volume 14, Number 11
https://doi.org/10.57264/cer-2025-0084
PDFFormats

Abstract

Aim: Bruton’s tyrosine kinase inhibitors (BTKis), including ibrutinib and acalabrutinib, transformed the treatment landscape of chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) by improving outcomes compared with chemoimmunotherapy. Real-world economic comparisons between BTKis are needed in diverse populations. This study aimed to compare healthcare costs in the Veterans Health Administration (VHA) among patients with CLL/SLL treated with, and remaining persistent on, first-line (1L) ibrutinib versus acalabrutinib monotherapy for 12 months. Materials & methods: This retrospective study used VHA electronic medical record data from January 2006 to July 2024. Eligible patients initiated 1L ibrutinib or acalabrutinib monotherapy on or after November 2019 and remained on continuous treatment for ≥12 months. All-cause and CLL/SLL-related costs were assessed over 12 months of follow-up. Generalized linear models were used to estimate adjusted costs and compare differences between treatment cohorts. Results: A total of 1059 patients were included (ibrutinib: n = 732; acalabrutinib: n = 327). During the 12-month follow-up of continuous 1L treatment, the annual adjusted all-cause total healthcare cost difference between ibrutinib and acalabrutinib was -$2422 (p = 0.46) (adjusted medical cost difference: $5259, p = 0.03; adjusted pharmacy cost difference: -$5886, p = 0.02). The annual adjusted CLL/SLL-related total healthcare cost difference between ibrutinib and acalabrutinib was -$3793 (p = 0.15) (adjusted medical cost difference: $2085, p = 0.05; adjusted pharmacy cost difference: -$5860, p = 0.02). Conclusion: Among VHA patients with CLL/SLL who initiated and remained on treatment with 1L BTKi monotherapy for 12 months, annual all-cause and CLL/SLL-related total healthcare costs were similar between ibrutinib and acalabrutinib. Pharmacy costs were lower for ibrutinib, while medical costs were lower for acalabrutinib, resulting in overall comparable total costs.

Plain language summary

What is this summary about?

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are common blood cancers in the US, especially among veterans. Two oral medications, ibrutinib and acalabrutinib, are commonly used as the first treatment for CLL/SLL. While both drugs are effective at improving disease outcomes, less is known about how much their use impacts healthcare cost in real-world settings, especially in the Veterans Health Administration, the largest US healthcare system for veterans. This study compared healthcare costs for patients with CLL/SLL who took either ibrutinib or acalabrutinib as their first treatment. It looked at 12 months of data after patients started, and remained on, treatment.

What were the results?

Results showed that total healthcare costs were similar between the two groups. Most costs came from the medications themselves. Although ibrutinib had slightly lower total healthcare costs, mainly because its pharmacy costs were lower, patients taking ibrutinib had higher outpatient care costs.

What do the results mean?

Patients taking ibrutinib had generally similar total healthcare costs compared with those taking acalabrutinib during the first year while on treatment, though medication costs were lower. These insights are important for understanding how these drugs impact healthcare spending, especially as drug pricing policies evolve.

Supplementary Material

File (supplementary data.docx)

References

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