The annual cost to manage patients with chronic lymphocytic leukemia (CLL) will reach $5.13 billion by 2025, which is a 590 percent increase from 2011, according to a study published in the Journal of Clinical Oncology.
Qiushi Chen, from the Georgia Institute of Technology, and authors used a simulation model to evaluate the management of CLL during this time period, using chemotherapy as the standard of care before 2014 and newer, oral therapies for patients with del17p and relapsed CLL as the standard of care from 2014 onward and for frontline treatment from 2016 forward.
Dr. Chen and authors projected that the number of people living with CLL in the United States will increase by 55 percent, from 128,000 patients in 2011 to 199,000 in 2025. They determined that if chemotherapy remained the standard of care, the cost increase would be approximately 26 percent; however, newer treatments will drive the cost up, with oral therapies accounting for 96 percent of treatments during the time period.
The model also projected a 125 percent increase in the per-person lifetime cost of CLL treatment, from $147,000 for patients who started therapy in 2011, compared with $331,000 for patients who started therapy in 2014. The model also predicted that patients who initiate oral agents in the frontline setting in 2016 will see a 310 percent increase in lifetime cost, from $147,000 to $604,000. Patients enrolled in Medicare are projected to see a 520 percent increase in total out-of-pocket costs, increasing from $9,200 to $57,000.
“Although the cost of cancer care is rising, the results indicate that the rising trend in the cost of CLL management will outpace that of other cancers,” the authors wrote.
The researchers also conducted a cost-effectiveness analysis and found that, compared with the chemotherapy scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life year.
“Oral ttherapies 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 authors concluded. “Such an economic impact could result in financial toxicity, limited access, and lower adherence to the oral therapies, which may undermine their clinical effectiveness.”
Source: Qiushi Chen, Nitin Jain, Turgay Ayer. Economic burden of chronic lymphocytic leukemia in the era of oral targeted therapies in the United States. J Clin Oncol. 2016 November 21. [Epub ahead of print]