Cost-utility analysis of acalabrutinib，zanubrutinib，and ibrutinib as first-line treatment for chronic lymphocytic leukemia
- VernacularTitle:阿可替尼、泽布替尼和伊布替尼一线治疗慢性淋巴细胞白血病的成本-效用分析
- Author:
Xinyue JI
1
;
Yufei WANG
1
;
Lei TIAN
2
Author Information
1. School of International Pharmaceutical Business，China Pharmaceutical University，Nanjing 211198，China;Center of Pharmacoeconomic Evaluation，China Pharmaceutical University，Nanjing 211198，China
2. School of International Pharmaceutical Business，China Pharmaceutical University，Nanjing 211198，China
- Publication Type:Journal Article
- Keywords:
acalabrutinib;
zanubrutinib;
ibrutinib;
Bruton’s tyrosine kinase inhibitor;
chronic lymphocytic leukemia;
pharmacoeconomic evaluation;
partitioned survival model;
cost-utility analysis
- From:
China Pharmacy
2026;37(15):2016-2022
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the cost-effectiveness of acalabrutinib， zanubrutinib， and ibrutinib as first-line treatments for patients with chronic lymphocytic leukemia （CLL）. METHODS A partitioned survival model was developed to simulate the 10-year disease progression of treatment-naive CLL patients. The model used a 4-week cycle length， and an annual discount rate of 4.5% was applied to both costs and health outcomes. Relevant clinical trial literature was systematically reviewed， and survival data for each treatment strategy were extracted. Using the ibrutinib arm from the RESONATE-2 trial as the anchor arm， an anchored indirect comparison approach was performed to estimate the relative treatment effects of acalabrutinib group and zanubrutinib group versus ibrutinib group. Survival curves for progression-free survival and overall survival for each treatment strategy were generated by combining the relative efficacy estimates with the survival data from the anchor arm. Quality-adjusted life year （QALY） were used as the model outcome measure. The incremental cost-effectiveness ratio and incremental net monetary benefit （INMB） were calculated to assess the economic value of the three treatment regimens. The willingness-to-pay （WTP） threshold was set at twice the 2025 per capita gross domestic product of China， corresponding to 199 330 yuan/QALY. One-way sensitivity analysis， probabilistic sensitivity analysis， and scenario analyses were conducted to evaluate the robustness of the base-case results. RESULTS In the base-case analysis， compared with ibrutinib group， both acalabrutinib group and zanubrutinib group demonstrated cost-saving and health-improving advantages. The INMBs were 149 361.37 yuan for acalabrutinib group and 194 783.94 yuan for zanubrutinib group， indicating that both strategies were dominant over ibrutinib. One-way sensitivity analysis showed that drug prices， hazard ratios between treatment strategies， and utility values were the major factors influencing the results. Probabilistic sensitivity analysis demonstrated that when the WTP threshold was below 450 000 yuan/QALY， acalabrutinib group and zanubrutinib group regimens consistently had higher probabilities of being cost-effective than ibrutinib group. Scenario analyses showed that acalabrutinib group and zanubrutinib group remained cost-effective compared with ibrutinib group under alternative assumptions， including different anchor arms， high-risk patient cohorts， and an extended 20-year time horizon. CONCLUSIONS Compared with ibrutinib， zanubrutinib and acalabrutinib can provide greater economic value as first-line treatments for CLL， with zanubrutinib demonstrating a more pronounced cost-effectiveness advantage.
