title: Economic Burden of Chronic Lymphocytic Leukemia in the Era of Oral Targeted Therapies in the United States.
abstract: Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward. A comparator scenario also was simulated where CIT remained the standard of care throughout. Disease progression and survival parameters for each therapy were based on published clinical trials. Results The number of people living with CLL in the United States is projected to increase from 128,000 in 2011 to 199,000 by 2025 (55% increase) due to improved survival; meanwhile, the annual cost of CLL management will increase from $0.74 billion to $5.13 billion (590% increase). The per-patient lifetime cost of CLL treatment will increase from $147,000 to $604,000 (310% increase) as oral targeted therapies become the first-line treatment. For patients enrolled in Medicare, the corresponding total out-of-pocket cost will increase from $9,200 to $57,000 (520% increase). Compared with the CIT scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life-year. Conclusion The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients.
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Qiushi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Jain
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Turgay
authors.initials: T
authors.lastname: Ayer
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: William G
authors.initials: WG
authors.lastname: Wierda
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keating
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Hagop M
authors.initials: HM
authors.lastname: Kantarjian
authors.affiliation: Qiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
authors.forename: Jagpreet
authors.initials: J
authors.lastname: Chhatwal
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000191:economics*; D008962:Models, Theoretical; D011788:Quality of Life; D014481:United States