Cost of CLL Management Expected to Skyrocket

By 2025 there will be an increasing number of people living with chronic lymphocytic leukemia (CLL) due to improved survival conferred by emerging targeted therapies; however, the annual cost of CLL management for both patients and providers may impose a significant financial burden, according to the results of a study published in the Journal of Clinical Oncology.

“The annual cost of CLL management is projected to reach $5.13 billion by 2025, a 590% increase from that in 2011,” wrote Qiushi Chen, of the Georgia Institute of Technology, and colleagues. “At the current price, oral therapies are not deemed cost-effective on the basis of the willingness-to-pay threshold of $100,000/QALY.”

In recent years, researchers have made significant strides in their understanding of the biology of CLL and this has led to advancements in the treatment of the disease in the form of targeted agents. However, these targeted agents have a high cost, and there are concerns about affordability.

With this study, Chen and colleagues used a simulation model to evaluate the evolving management of CLL from 2011 to 2025 using chemotherapy as the standard of care before 2014, oral targeted therapies for patients with del (17p) and relapsed CLL as the standard from 2014, and for first-line treatment from 2016 forward.

Using this model, they projected that the number of people living with CLL in the United States will increase by 55% from 128,000 in 2011 to 199,000 in 2025. If chemotherapy remained the standard of care, this increase would only be about 26%. During this time, newer treatments will result in a 590% increase in the annual cost of CLL management from $0.74 billion to $5.13 billion. Of the total cost of management, oral targeted therapy would account for 96%.

“The first surge in the annual cost occurred in 2014 when oral targeted therapies became available for patients who relapsed, and the second surge will occur in 2016 because of the approval of oral targeted therapy in the first-line setting,” the researchers wrote. “In contrast to the increasing cost trend with oral targeted therapies, the annual cost under the chemotherapy scenario would have remained relatively stable from 2014 on, reaching $1.12 billion in 2025.”

The model also projected a 125% increase in the per-person lifetime cost of CLL treatment from $147,000 for patients who started therapy in 2011 to $331,000 for patients who started therapy in 2014. Patients who initiate therapy using oral targeted agents in the first-line setting in 2016 will see a 310% increase in lifetime cost, from $147,000 to $604,000. Finally, patients enrolled in Medicare were projected to have a 520% increase in total out-of-pocket cost 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 researchers wrote. “The annual cost of cancer care in the United States is expected to increase by 27% to 50% from $143 billion in 2010 to $180 billion in 2020.”

In contrast to other cancers, the over 500% projected increase in cost for CLL is driven by oral targeted therapies and prolonged treatment duration, according to the researchers.

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 targeted therapies 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 researchers wrote. “Such an economic impact could result in financial toxicity, limited access, and lower adherence to the oral therapies, which may undermine their clinical effectiveness.”