A Markov model-based cost-effectiveness analysis comparing zanubrutinib to ibrutinib for treating relapsed and refractory chronic lymphocytic leukemia

ABSTRACT

Objective

This article examined the cost-effectiveness of zanubrutinib and ibrutinib for managing relapsed and refractory chronic lymphocytic leukemia from the viewpoint of payers in China and the US.

Methods

Markov models were employed to conduct comparisons. Baseline characteristics and clinical data were extracted from the ALPINE study. The cost-effectiveness outcome indicators encompassed cost, quality-adjusted life years, and the incremental cost-effectiveness ratio.

Results

The Markov model analysis revealed that the zanubrutinib group incurred an incremental cost per patient of $-24,586.53 compared to the ibrutinib group. The zanubrutinib group exhibited an incremental utility per capita of 0.28 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio of $-88,068.16 per quality-adjusted life year, which is lower than the payment threshold in China. The willingness-to-pay value in China for 2022 was three times the country’s gross domestic product per capita. In the US, patients in the zanubrutinib group experienced per capita incremental costs of $-79,421.56, per capita incremental utility of 0.28 quality-adjusted life years, and an incremental cost-effectiveness ratio of $-284,485.45 per quality-adjusted life year.

Conclusion

For Chinese payers, zanubrutinib exhibited superior cost-effectiveness compared to ibrutinib. Zanubrutinib proved to be a more affordable option for US payers when considering the payment threshold.

KEYWORDS:

• Ibrutinib
• zanubrutinib
• cost-effectiveness
• pharmacoeconomic evaluation
• relapsed refractory chronic lymphocytic leukemia

Article highlights

•The ALPINE trial motivated great interest for health-care decision-makers after the reports of the clinical benefit and safety profile from zanubrutinib for patients with relapsed and refractory chronic lymphocytic leukemia

•The purpose of this analysis was to assess the cost-effectiveness of zanubrutinib or ibrutinib as first-line therapy for patients with relapsed and refractory chronic lymphocytic leukemia from a payer perspective.

•Compared to compared to ibrutinib,zanubrutinib may be a cost-effective treatment option for patients with relapsed refractory chronic lymphocytic leukemia in China and the US.

•The per capita cost of zanubrutinib was $79,421.56 lower than ibrutinib in the US model. The ICER was $-284,485.45/QALY, which is below the US willingness-to-pay threshold.

•The results of this study will help policy makers to make informed resource allocation choices based on the actual situation.

Declarations of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Z.Y. Zhou and X.H. Zhang designed the study and contributed to the writing and revision of the manuscript; R.Q. Li, C.X. Wang, Z.J. Ye, Y.Z. Chen, and J.Y. Xu performed the experiments; C. Chen, J.H. Yang, J. Fu, and T. Zhou analyzed the experimental data; R.Q. Li contributed to the writing of the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2288683

Additional information

Funding

This work was supported by Research Support Project for Pharmacoeconomics and Health Technology Evaluation of Zhejiang Provincial Pharmaceutical Association under Grant No. 2022ZYJ21, Medical Health Science and Technology Project of Zhejiang Provincial Health Commission under Grant No. 2019KY448 and A Project Supported by Scientific Research Fund of Zhejiang Provincial Education Department under Grant No. Y202250087.