{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:59:12Z","timestamp":1793386752728,"version":"4.5.0"},"reference-count":44,"publisher":"Becaris Publishing Limited","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Comp. Eff. Res."],"abstract":"<jats:p>\n            <jats:bold>Aim:<\/jats:bold>\n            To estimate cost savings associated with covalent Bruton\u2019s tyrosine kinase inhibitor (cBTKi) choice in patients with treatment-naive (TN) and relapsed\/refractory (RR) chronic lymphocytic leukemia (CLL) from a Medicare perspective.\n            <jats:bold>Materials<\/jats:bold>\n            <jats:bold>&amp;<\/jats:bold>\n            <jats:bold>methods:<\/jats:bold>\n            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 \u22653 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\u00a0years.\n            <jats:bold>Results:<\/jats:bold>\n            A cohort of 13,726 patients with CLL was modeled (44% TN, 56% RR). Acalabrutinib\u2019s aggregate grade \u22653 AE rate was 25.8%\u00a0points less in TN patients (35.8% vs 61.6%) and 8.0%\u00a0points less in RR patients (75.0% vs 83.0%) compared with ibrutinib, and 20.6%\u00a0points less in TN patients (35.8% vs 56.4%) and 11.1%\u00a0points 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 a Medicare perspective. Acalabrutinib cost savings persisted over 3 and 5\u00a0years.\n            <jats:bold>Conclusion:<\/jats:bold>\n            Acalabrutinib yielded cost savings versus ibrutinib and zanubrutinib for patients with CLL in Medicare due to lower treatment cost versus ibrutinib and fewer grade \u22653 AEs versus both ibrutinib and zanubrutinib.\n          <\/jats:p>","DOI":"10.57264\/cer-2025-0035","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T06:08:36Z","timestamp":1750658916000},"source":"Crossref","is-referenced-by-count":4,"title":["Cost impact of Bruton\u2019s tyrosine kinase inhibitor selection in Medicare patients with chronic lymphocytic leukemia"],"prefix":"10.57264","author":[{"given":"Adam S","family":"Kittai","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, NY, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipen A","family":"Patel","sequence":"additional","affiliation":[{"name":"AstraZeneca, Gaithersburg, MD 20878, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8444-5979","authenticated-orcid":false,"given":"Jason","family":"Shafrin","sequence":"additional","affiliation":[{"name":"FTI Consulting, Washington, DC 20004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Zawadzki","sequence":"additional","affiliation":[{"name":"FTI Consulting, Washington, DC 20004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram S","family":"Shetty","sequence":"additional","affiliation":[{"name":"AstraZeneca, Gaithersburg, MD 20878, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazan K","family":"Barqawi","sequence":"additional","affiliation":[{"name":"AstraZeneca, Gaithersburg, MD 20878, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna M","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Rutgers Cancer Institute, NJ 08901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"36897","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"issue":"25","key":"e_1_3_7_3_2","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1182\/blood-2017-09-806398","article-title":"iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL","volume":"131","author":"Hallek M","year":"2018","unstructured":"Hallek M, Cheson BD, Catovsky D iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood 131(25), 2745\u20132760 (2018).","journal-title":"Blood"},{"key":"e_1_3_7_4_2","unstructured":"SEER*Explorer: an interactive website for SEER cancer statistics [online]. National Cancer Institute Surveillance Research Program Accessed 24 November 2024: https:\/\/seer.cancer.gov\/statistics-network\/explorer\/"},{"key":"e_1_3_7_5_2","unstructured":"Cancer Stat Facts: Leukemia - Chronic Lymphocytic Leukemia (CLL). Surveillance epidemiology and end results (SEER) [online]. National Cancer Institute Accessed 24 November 2024: https:\/\/seer.cancer.gov\/statfacts\/html\/clyl.html"},{"key":"e_1_3_7_6_2","first-page":"132040620722111","article-title":"Selecting the optimal BTK inhibitor therapy in CLL: rationale and practical considerations","author":"Lovell AR","year":"2022","unstructured":"Lovell AR, Jammal N, Bose P. Selecting the optimal BTK inhibitor therapy in CLL: rationale and practical considerations. Ther. Adv. Hematol. 1320406207221116577 (2022).","journal-title":"Ther. Adv. 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Oncol. 39(31), 3441\u20133452 (2021).","journal-title":"J. Clin. Oncol."},{"key":"e_1_3_7_9_2","first-page":"142202","article-title":"Extended follow-up of ALPINE randomized phase III study confirms sustained superior progression-free survival of zanubrutinib versus ibrutinib for treatment of relapsed\/refractory chronic lymphocytic leukemia and small lymphocytic lymphoma (R\/R CLL\/SLL)","author":"Brown JR","year":"2023","unstructured":"Brown JR, Eichhorst B, Lamanna N Extended follow-up of ALPINE randomized phase III study confirms sustained superior progression-free survival of zanubrutinib versus ibrutinib for treatment of relapsed\/refractory chronic lymphocytic leukemia and small lymphocytic lymphoma (R\/R CLL\/SLL). Blood 142202 (2023). https:\/\/www.beigenemedical.com\/CongressDocuments\/Brown_BGB-3111-305_ASH_Presentation_2023.pdf","journal-title":"Blood"},{"issue":"10","key":"e_1_3_7_10_2","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1080\/10428194.2021.1913144","article-title":"Matching-adjusted indirect comparisons of safety and efficacy of acalabrutinib versus other targeted therapies in patients with treatment-na\u00efve chronic lymphocytic leukemia","volume":"62","author":"Davids MS","year":"2021","unstructured":"Davids MS, Telford C, Abhyankar S, Waweru C, Ringshausen I. Matching-adjusted indirect comparisons of safety and efficacy of acalabrutinib versus other targeted therapies in patients with treatment-na\u00efve chronic lymphocytic leukemia. Leuk. Lymphoma 62(10), 2342\u20132351 (2021).","journal-title":"Leuk. 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