Economic Burden of Targeted Therapy Use in CLL Patients

Nitin Jain, MD

Today, ahead of the American Society of Hematology meeting, being held in Orlando, Florida from December 5th to the 8th, we are speaking with Nitin Jain, assistant professor in the department of leukemia at the University of Texas MD Anderson in Houston. Dr. Jain will present an analysis on the economic burden of targeted agents for chronic lymphocytic leukemia. His talk, "Prevalence and Economic Burden of Chronic Lymphocytic Leukemia [CLL] n the Era of Oral Targeted Therapies" will be on Monday, December 7th at the meeting.¹

-Interviewed by Anna Azvolinsky, PhD

--Interview by Anna Azvolinsky, PhD

OncoTherapy Network: Dr. Jain, let’s start with the targeted agents included in this analysis. Could you talk about these and which patients are eligible, and typically how long do patients stay on treatment?

Dr. Jain: This study was designed primarily to look at currently FDA-approved targeted agents for patients with CLL including ibrutinib, idelalisib, drugs such as obinutuzumab. So we included all these agents in this analysis to look at the projected cost would be when these targeted agents are approved for patients with CLL. Some of these are already approved in the relapsed setting and we expect that these agents will get approved for patients in the frontline setting for patients with CLL. So, the purpose of this study was to look at the cost burden of these new oral, targeted agents.  We did a national level survey of all patients, the prevalence of the patients and how many patients will get each respective treatment based on the data from clinical trials that we know so far.

OncoTherapy Network: What do we know so far about the costs of these treatments and do you expect to cost to rise much higher once these agents are used as first-line therapies?

Dr. Jain: That is something that we looked at before starting this analysis. And with the oral targeted therapies which are given for an indefinite period of time and these are quite expensive drugs versus chemotherapy, which are generally given for a short duration of time, generally 6 cycles or 6 months of treatment. It looked like when we started analyzing these targeted therapies for a large majority of patients with CLL, the number of patients on these therapies will increase and the cost burden, the total cost burden of CLL care would increase. So in this particular analysis we did a modeling to factor in how that economic burden will increase, what is the current economic burden of the cost of CLL, and then the projected over the course of the next 10 years as these therapies are developed and come into the market and become commercially available, what the expected cost burden for CLL will be 10 years down the line.

OncoTherapy Network: Could you talk about what went into the CLL cost burden analysis. Maybe a little bit about what you found?

Dr. Jain: Sure. We factored several aspects of the CLL cost burden. So the most important was the drug cost, the actual cost of the drug and we used the average wholesale price of these drugs. So, for example most of the newer targeted agents are priced at over $100,000 a year. So we factored into that cost the price of the drug. We also looked at the administration cost which would be the cost of using an infusion therapy suite for particular drug. We also added the adverse event cost, such as those expected with either chemotherapy or targeted agents. And then we also factored in follow-up cost which is how often patients are turning to physicians for a visit, a blood test, for imaging studies, and we added all these together for each individual treatment regimen. Then we modeled it to say what would be the cost in the chemotherapy era where just the chemotherapy is available and then what would be the projected cost when these targeted therapies are available. Basically, what we found is that as targeted therapies are going to be available commonly for patients with CLL, we are going to see that there is an increase in the total cost burden of management of patients with CLL. Now, obviously these new targeted therapies are quite effective and patients are living longer. So these have revolutionized the treatment of CLL, but at the same time that comes at an increasing cost burden. So the message of our abstract is that a more appropriate drug price rising should be entertained for these newer therapies for CLL.

OncoTherapy Network: Just lastly, are you following up this modeling work by collecting any real world clinical data? And also, how has the cost burden for CLL, how does that fit into the overall high cost of cancer drugs as a whole? Anything you can say about that?

Dr. Jain: Right, so this modeling work, we considered the entire United States as the target population so we calculated the cost based on the current prevalence of the disease in the United States and then what we expect the prevalence to be 10 years down the line given that the patients will be living longer. So we kind of did this modeling work at the entire United States level to say that the cost burden analysis is applicable to the entire population. Now, we did make a number of assumptions as is true of any modeling work. We used the clinical trial data which is obviously a smaller subset of patients who are getting treatment, to make predictions about how much longer patients will be living, how much time they will be on a particular drug, and what side effects they may experience. So, definitely there are a lot of assumptions made for this modeling work, but we think that this is pretty close to what the real world data will be moving forward. Now, your question of how this fares compared to the general argument of the high cost of cancer drugs, I think this is right into that area where this is probably not just true for CLL, but for other diseases where with the high price of cancer drugs, we are seeing the cost burden increase. I think our analysis shows that this is also true for patients with CLL.

OncoTherapy Network: Thank you so much for joining us today, Dr. Jain.

Dr. Jain: Thank you very much.

References:

• American Society of Hematology. (2015). Prevalence and Economic Burden of Chronic Lymphocytic Leukemia (CLL) in the Era of Oral Targeted Therapies. American Society of Hematology's 57^th Annual Meeting & Exposition, December 5-8, 2015.