PURPOSE: To evaluate the impact of approval of ibrutinib and idelalisib on pharmaceutical costs in the treatment of chronic lymphocytic leukemia (CLL) at the societal level and assess individual out-of-pocket costs under Medicare Part D. METHODS: Average wholesale price of commonly used CLL treatment regimens was ascertained from national registries. Using the population of Olmsted County, Minnesota, we identified the proportion of patients with newly diagnosed CLL who experience progression to the point of requiring treatment. Using these data, total pharmaceutical cost over a 10-year period after diagnosis was estimated for a hypothetic cohort of 100 newly diagnosed patients under three scenarios: before approval of ibrutinib and idelalisib (historical scenario), after approval of ibrutinib and idelalisib as salvage therapy (current scenarios A and B), and assuming use of ibrutinib as first-line treatment (potential future scenario). RESULTS: Estimated 10-year pharmaceutical costs for 100 newly diagnosed patients were as follows: $4,565,929 (approximately $45,659 per newly diagnosed patient and $157,446 per treated patient) for the historical scenario, $7,794,843 (approximately $77,948 per newly diagnosed patient and $268,788 per treated patient) for current scenario A, $6,309,162 (approximately $63,092 per newly diagnosed patient and $217,557 per treated patient) for current scenario B, and $16,414,055 (approximately $164,141 per newly diagnosed patient and $566,002 per treated patient) for the potential future scenario. Total out-of-pocket cost for 100 patients with newly diagnosed CLL under Medicare Part D increased from $9,426 under the historical scenario (approximately $325 per treated patient) to $363,830 and $255,051 under current scenarios A and B (approximately $8,800 to $12,500 per treated patient) and to $1,031,367 (approximately $35,564 per treated patient) under the future scenario. CONCLUSION: Although ibrutinib and idelalisib are profound treatment advances, they will dramatically increase individual out-of-pocket and societal costs of caring for patients with CLL. These cost considerations may undermine the potential promise of these agents by limiting access and reducing adherence.
PURPOSE: To evaluate the impact of approval of ibrutinib and idelalisib on pharmaceutical costs in the treatment of chronic lymphocytic leukemia (CLL) at the societal level and assess individual out-of-pocket costs under Medicare Part D. METHODS: Average wholesale price of commonly used CLL treatment regimens was ascertained from national registries. Using the population of Olmsted County, Minnesota, we identified the proportion of patients with newly diagnosed CLL who experience progression to the point of requiring treatment. Using these data, total pharmaceutical cost over a 10-year period after diagnosis was estimated for a hypothetic cohort of 100 newly diagnosed patients under three scenarios: before approval of ibrutinib and idelalisib (historical scenario), after approval of ibrutinib and idelalisib as salvage therapy (current scenarios A and B), and assuming use of ibrutinib as first-line treatment (potential future scenario). RESULTS: Estimated 10-year pharmaceutical costs for 100 newly diagnosed patients were as follows: $4,565,929 (approximately $45,659 per newly diagnosed patient and $157,446 per treated patient) for the historical scenario, $7,794,843 (approximately $77,948 per newly diagnosed patient and $268,788 per treated patient) for current scenario A, $6,309,162 (approximately $63,092 per newly diagnosed patient and $217,557 per treated patient) for current scenario B, and $16,414,055 (approximately $164,141 per newly diagnosed patient and $566,002 per treated patient) for the potential future scenario. Total out-of-pocket cost for 100 patients with newly diagnosed CLL under Medicare Part D increased from $9,426 under the historical scenario (approximately $325 per treated patient) to $363,830 and $255,051 under current scenarios A and B (approximately $8,800 to $12,500 per treated patient) and to $1,031,367 (approximately $35,564 per treated patient) under the future scenario. CONCLUSION: Although ibrutinib and idelalisib are profound treatment advances, they will dramatically increase individual out-of-pocket and societal costs of caring for patients with CLL. These cost considerations may undermine the potential promise of these agents by limiting access and reducing adherence.
Authors: Davide Rossi; Lodovico Terzi-di-Bergamo; Lorenzo De Paoli; Michaela Cerri; Guido Ghilardi; Annalisa Chiarenza; Pietro Bulian; Carlo Visco; Francesca R Mauro; Fortunato Morabito; Agostino Cortelezzi; Francesco Zaja; Francesco Forconi; Luca Laurenti; Ilaria Del Giudice; Massimo Gentile; Iolanda Vincelli; Marina Motta; Marta Coscia; Gian Matteo Rigolin; Alessandra Tedeschi; Antonino Neri; Roberto Marasca; Omar Perbellini; Carol Moreno; Giovanni Del Poeta; Massimo Massaia; Pier Luigi Zinzani; Marco Montillo; Antonio Cuneo; Valter Gattei; Robin Foà; Gianluca Gaidano Journal: Blood Date: 2015-08-14 Impact factor: 22.113
Authors: Tait D Shanafelt; Xin V Wang; Neil E Kay; Curtis A Hanson; Susan O'Brien; Jacqueline Barrientos; Diane F Jelinek; Esteban Braggio; Jose F Leis; Cong C Zhang; Steven E Coutre; Paul M Barr; Amanda F Cashen; Anthony R Mato; Avina K Singh; Michael P Mullane; Richard F Little; Harry Erba; Richard M Stone; Mark Litzow; Martin Tallman Journal: N Engl J Med Date: 2019-08-01 Impact factor: 91.245
Authors: Matthew S Davids; Danielle M Brander; Haesook T Kim; Svitlana Tyekucheva; Jad Bsat; Alexandra Savell; Jeffrey M Hellman; Josie Bazemore; Karen Francoeur; Alvaro Alencar; Leyla Shune; Mohammad Omaira; Caron A Jacobson; Philippe Armand; Samuel Ng; Jennifer Crombie; Ann S LaCasce; Jon Arnason; Ephraim P Hochberg; Ronald W Takvorian; Jeremy S Abramson; David C Fisher; Jennifer R Brown Journal: Lancet Haematol Date: 2019-06-14 Impact factor: 18.959
Authors: James I Barnes; Vasu Divi; Adrian Begaye; Russell Wong; Steven Coutre; Douglas K Owens; Jeremy D Goldhaber-Fiebert Journal: Blood Adv Date: 2018-08-14