Background: Bruton tyrosine kinase inhibitors (BTKis) represent an advancement in chronic lymphocytic leukemia; however, these agents are administered continuously until disease progression or unacceptable toxicity, raising concerns about their affordability. Venetoclax in combination with obinutuzumab (VO) is a fixed-duration (12-month) treatment, approved in Canada in 2020. This study estimated the total cumulative cost of different treatment sequences and evaluated the economic impact of introducing treatment sequences with/without VO, from a Canadian health care system perspective. Methods: A 10-year partitioned survival model was developed, considering key clinical parameters and direct medical costs. Results were stratified by TP53 aberration. Results: Treatment sequences starting with first-line (1L) VO resulted in lower 10-year cumulative costs compared to sequences starting with BTKis administered until disease progression, across both TP53 aberration subgroups. With a maximum of three lines of treatment over a 10-year period, cumulative costs were largely determined by the first two lines of treatment. When comparing sequences with the same 1L treatment, sequences with BTKis in second-line incurred greater costs compared to fixed-duration regimens. Conclusions: Overall, the economic impact of treating all patients with VO led to 10-year cumulative savings of CAD 169,341 and CAD 293,731 per patient, without and with TP53 aberration, respectively. These savings are mainly due to reductions in treatment costs associated with fixed treatment duration.
背景：布鲁顿酪氨酸激酶抑制剂（BTKi）代表了慢性淋巴细胞白血病治疗的一大进展；然而，这些药物需持续使用直至疾病进展或出现不可耐受的毒性，这引发了对其经济可负担性的担忧。维奈克拉联合奥妥珠单抗（VO）是一种固定疗程（12个月）的治疗方案，于2020年在加拿大获批。本研究从加拿大医疗体系的角度，估算了不同治疗序列的累计总成本，并评估了引入含或不含VO的治疗序列所产生的经济影响。 方法：本研究构建了一个10年分区生存模型，纳入了关键临床参数和直接医疗成本。结果按TP53基因异常状态进行分层分析。 结果：在TP53基因异常的两个亚组中，与起始使用BTKi直至疾病进展的治疗序列相比，起始采用一线（1L）VO的治疗序列在10年内的累计成本更低。在10年期间最多接受三线治疗的情况下，累计成本主要由前两线治疗决定。当比较具有相同一线治疗的序列时，二线采用BTKi的治疗序列相比固定疗程方案会产生更高的成本。 结论：总体而言，对所有患者采用VO治疗所产生的经济影响，在无TP53基因异常和伴有TP53基因异常的患者中，分别实现了每位患者10年累计节省169,341加元和293,731加元。这些节省主要归因于固定治疗时长带来的治疗成本降低。
肿瘤(癌症)患者之家