Blood: The cost-effectiveness of using Ilutinib as a first-line therapy in CLL patients

The ALLIANCE trial found that the continued use of ilutinib significantly extended the patient's progression-free survival compared to the treatment of elderly patients with chronic lymphocytic leukemia (CLL) in the course of rituximab and phenyartina fixed course of treatmentFor the study, the researchers created a Markov model to assess the cost-benefit of using ilutini on the front line and compare it with the strategy of using Ilutinib as a third-line treatment after the failure of the benzenemm and venetoclax programmeThe transfer probability of randomized experiment is estimated by parameter survival modelLifetime direct health care costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICERs) were calculated from the perspective of U.SpayersThe first-line use of Irutinib improves QALYs compared to third-line therapy, but significantly increases the cost of medical care (cost increases of $612,700), resulting in ICER at $2,350,041/QALYThe monthly cost of Ilutini as a first-line therapy needs to be reduced by 72% to meet the cost-effectiveness of the $150,000/QALY thresholdThe incremental cost of first-line use of Ilutinib was $478,823 compared to second-line therapy, with an incremental effectiveness of 0.05 QALYs and ICER of $9,810,360/QALYThese data suggest that front-line use of Ilutinib is unlikely to be cost-effective for senior CLL patients at current pricesFor most CLL patients, delaying the use of Ilutinib (second- and third-line) until advanced treatment may be a reasonable strategy to limit medical costs without affecting clinical outcomes