DOI: 10.6084/m9.figshare.29380466.v1
title: Supplementary materials: Cost impact of Bruton’s tyrosine kinase inhibitor selection in Medicare patients with chronic lymphocytic leukemia

description: <b>These are peer-reviewed supplementary materials for the article</b><b> </b><b>'</b><b>Cost impact of Bruton’s tyrosine kinase </b><b>inhibitor selection in Medicare patients </b><b>with chronic lymphocytic leukemia</b><b>'</b><b> </b><b>published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Supplementary Methods</b><br><b>Supplementary Table 1: Additional model inputs</b><b>Supplementary Table 2: </b>Grade ≥3 cBTKi AE rates informed by published matching-adjusted indirect comparisons<b>Supplementary Table 3: </b>Inputs for scenario analysis varying cBTKi discontinuation rates<b>Supplementary Table 4: </b>Medical, pharmacy, and total costs associated with acalabrutinib, ibrutinib, and zanubrutinib among patients with CLL in Medicare over time<b>Supplementary Table 5: </b>Medical, pharmacy, and total costs associated with acalabrutinib, ibrutinib, and zanubrutinib among Model outcomes among CMS special subpopulations with CLL in Medicare<b>Supplementary Table 6: </b>Scenario analysis results<b>Supplementary Figure 1: </b>Deterministic sensitivity analysis: difference in 1 year total cost per patient with acalabrutinib versus ibrutinib, top 10 most sensitive parameters<b>Supplementary Figure 2: </b>Deterministic sensitivity analysis: difference in 3 year total cost per patient with acalabrutinib versus ibrutinib, top 10 most sensitive parameters<b>Supplementary Figure 3: </b>Deterministic sensitivity analysis: difference in 5 year total cost per patient with acalabrutinib versus ibrutinib, top 10 most sensitive parameters<b>Supplementary Figure 4: </b>Deterministic sensitivity analysis: difference in 1 year total cost per patient with acalabrutinib versus zanubrutinib, top 10 most sensitive parameters<b>Supplementary Figure 5: </b>Deterministic sensitivity analysis: difference in 3 year total cost per patient with acalabrutinib versus zanubrutinib, top 10 most sensitive parameters<b>Supplementary Figure 6:</b> Deterministic sensitivity analysis: difference in 5 year total cost per patient with acalabrutinib versus zanubrutinib, top 10 most sensitive parameters<b>Supplementary Figure 7: </b>Probabilistic analysis: difference in AE costs versus difference in pharmacy costs in 5,000 iterated scenarios (acalabrutinib versus ibrutinib; 3 years)<b>Supplementary Figure 8: </b>Probabilistic analysis: difference in AE costs versus difference in pharmacy costs in 5,000 iterated scenarios (acalabrutinib versus ibrutinib; 5 years)<b>Supplementary Figure 9:</b> Probabilistic analysis: difference in AE costs versus difference in pharmacy costs in 5,000 iterated scenarios (acalabrutinib versus zanubrutinib; 3 years)<b>Supplementary Figure 10: </b>Probabilistic analysis: difference in AE costs versus difference in pharmacy costs in 5,000 iterated scenarios (acalabrutinib versus zanubrutinib; 5 years)<b>Aim:</b> To estimate cost savings associated with covalent Bruton’s tyrosine kinase inhibitor (cBTKi) choice in patients with treatment-naive (TN) and relapsed/refractory (RR) chronic lymphocytic leukemia (CLL) from a Medicare perspective. <b>Materials & methods:</b> An economic model with Markov structure simulated outcomes in patients with CLL initiating ibrutinib, acalabrutinib or zanubrutinib monotherapy. Modeled population included TN and RR patients who had no prior cBTKi. Treatments were dosed per US FDA label and efficacy assumed identical across cBTKis. Cumulative grade ≥3 adverse event (AE) rates were drawn from extended follow-up of cBTKi phase III clinical trials at similar duration. Costs included drug price per 2024 wholesale acquisition cost and AE management medical costs from literature, adjusted for Medicare reimbursement. Outcomes were total change in payer cost over 1, 3 and 5 years. <b>Results: </b>A cohort of 13,726 patients with CLL was modeled (44% TN, 56% RR). Acalabrutinib’s aggregate grade ≥3 AE rate was 25.8% points less in TN patients (35.8% vs 61.6%) and 8.0% points less in RR patients (75.0% vs 83.0%) compared with ibrutinib, and 20.6% points less in TN patients (35.8% vs 56.4%) and 11.1% points less in RR patients (75.0% vs 86.1%) compared with zanubrutinib. Acalabrutinib saved $15,478 more per patient versus ibrutinib in year 1 due to lower treatment cost (-$12,076) and lower AE cost (-$3402). Acalabrutinib also saved $1901 more per patient versus zanubrutinib as acalabrutinib higher treatment cost (+$1663) was offset by lower AE cost (-$3563). Across all patients, acalabrutinib saved $212 million more versus ibrutinib and $26 million more versus zanubrutinib from aMedicare perspective. Acalabrutinib cost savings persisted over 3 and 5 years.<b> Conclusion:</b> Acalabrutinib yielded cost savings versus ibrutinib and zanubrutinib for patients with CLL in Medicare due to lower treatment cost versus ibrutinib and fewer grade ≥3 AEs versus both ibrutinib and zanubrutinib.<br>