{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:19:23Z","timestamp":1761905963676,"version":"build-2065373602"},"reference-count":34,"publisher":"Becaris Publishing Limited","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Comp. Eff. Res."],"published-print":{"date-parts":[[2025,11]]},"abstract":"\n Aim:<\/jats:bold>\n Bruton\u2019s tyrosine kinase inhibitors (BTKis), including ibrutinib and acalabrutinib, transformed the treatment landscape of chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) by improving outcomes compared with chemoimmunotherapy. Real-world economic comparisons between BTKis are needed in diverse populations. This study aimed to compare healthcare costs in the Veterans Health Administration (VHA) among patients with CLL\/SLL treated with, and remaining persistent on, first-line (1L) ibrutinib versus acalabrutinib monotherapy for 12\u00a0months.\n Materials & methods:<\/jats:bold>\n This retrospective study used VHA electronic medical record data from January 2006 to July 2024. Eligible patients initiated 1L ibrutinib or acalabrutinib monotherapy on or after November 2019 and remained on continuous treatment for \u226512\u00a0months. All-cause and CLL\/SLL-related costs were assessed over 12\u00a0months of follow-up. Generalized linear models were used to estimate adjusted costs and compare differences between treatment cohorts.\n Results:<\/jats:bold>\n A total of 1059 patients were included (ibrutinib: n\u00a0=\u00a0732; acalabrutinib: n\u00a0=\u00a0327). During the 12-month follow-up of continuous 1L treatment, the annual adjusted all-cause total healthcare cost difference between ibrutinib and acalabrutinib was -$2422 (p\u00a0=\u00a00.46) (adjusted medical cost difference: $5259, p\u00a0=\u00a00.03; adjusted pharmacy cost difference: -$5886, p\u00a0=\u00a00.02). The annual adjusted CLL\/SLL-related total healthcare cost difference between ibrutinib and acalabrutinib was -$3793 (p\u00a0=\u00a00.15) (adjusted medical cost difference: $2085, p\u00a0=\u00a00.05; adjusted pharmacy cost difference: -$5860, p\u00a0=\u00a00.02).\n Conclusion:<\/jats:bold>\n Among VHA patients with CLL\/SLL who initiated and remained on treatment with 1L BTKi monotherapy for 12\u00a0months, annual all-cause and CLL\/SLL-related total healthcare costs were similar between ibrutinib and acalabrutinib. Pharmacy costs were lower for ibrutinib, while medical costs were lower for acalabrutinib, resulting in overall comparable total costs.\n <\/jats:p>","DOI":"10.57264\/cer-2025-0084","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T10:35:08Z","timestamp":1760438108000},"source":"Crossref","is-referenced-by-count":0,"title":["Healthcare cost comparison between first-line ibrutinib and acalabrutinib in chronic lymphocytic leukemia patients in the Veterans Affairs"],"prefix":"10.57264","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5988-2878","authenticated-orcid":false,"given":"Lindsey","family":"Fitzgerald","sequence":"first","affiliation":[{"name":"Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA"},{"name":"George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabyasachi","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, a Johnson & Johnson Company, Horsham, PA 19044, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2622-6513","authenticated-orcid":false,"given":"Alex","family":"Bokun","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, a Johnson & Johnson Company, Horsham, PA 19044, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9577-8904","authenticated-orcid":false,"given":"Angela","family":"Lax","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc., Boston, MA 02199, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fan","family":"Mu","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc., Boston, MA 02199, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Wu","sequence":"additional","affiliation":[{"name":"Analysis Group, Inc., Boston, MA 02199, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7040-4287","authenticated-orcid":false,"given":"Yilu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Health Policy & Management, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70112, USA"},{"name":"Southeast Louisiana Veterans Health Care System, New Orleans, LA 70119, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7827-6766","authenticated-orcid":false,"given":"Lizheng","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Health Policy & Management, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70112, USA"},{"name":"Southeast Louisiana Veterans Health Care System, New Orleans, LA 70119, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9605-3980","authenticated-orcid":false,"given":"Zaina P","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs, a Johnson & Johnson Company, Horsham, PA 19044, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9475-3016","authenticated-orcid":false,"given":"Solomon A","family":"Graf","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA"},{"name":"Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA"},{"name":"Hospital & Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"36897","reference":[{"issue":"1","key":"e_1_3_10_3_2","first-page":"7","article-title":"Cancer statistics, 2020","volume":"70","author":"Siegel RL","year":"2020","unstructured":"Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J. Clin. 70(1), 7\u201330 (2020).","journal-title":"CA Cancer J. Clin."},{"key":"e_1_3_10_4_2","unstructured":"National Cancer Institute. Cancer stat facts: NHL \u2014 chronic lymphocytic leukemia\/small lymphocytic lymphoma (CLL\/SLL). (2021). Available from: https:\/\/seer.cancer.gov\/statfacts\/html\/cllsll.html"},{"key":"e_1_3_10_5_2","doi-asserted-by":"crossref","first-page":"686768","DOI":"10.3389\/fimmu.2021.686768","article-title":"BTK Inhibitors in chronic lymphocytic leukemia: biological activity and immune effects","volume":"12","author":"Palma M","year":"2021","unstructured":"Palma M, Mulder TA, \u00d6sterborg A. BTK Inhibitors in chronic lymphocytic leukemia: biological activity and immune effects. Front. Immunol. 12, 686768 (2021).","journal-title":"Front. Immunol."},{"key":"e_1_3_10_6_2","first-page":"66","article-title":"Imbruvica (Ibrutinib), first-in-class Bruton's tyrosine kinase inhibitor, receives expanded indications for patients with relapsed chronic lymphocytic leukemia","volume":"8","author":"Raedler LA","year":"2015","unstructured":"Raedler LA. Imbruvica (Ibrutinib), first-in-class Bruton's tyrosine kinase inhibitor, receives expanded indications for patients with relapsed chronic lymphocytic leukemia. Am. Health Drug Benefits 8(Spec. Feature), 66\u201369 (2015).","journal-title":"Am. Health Drug Benefits"},{"issue":"25","key":"e_1_3_10_7_2","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1056\/NEJMoa1509388","article-title":"Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia","volume":"373","author":"Burger JA","year":"2015","unstructured":"Burger JA, Tedeschi A, Barr PM Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. N. Engl. J. Med. 373(25), 2425\u20132437 (2015).","journal-title":"N. Engl. J. Med."},{"issue":"10232","key":"e_1_3_10_8_2","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S0140-6736(20)30262-2","article-title":"Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, Phase III trial","volume":"395","author":"Sharman JP","year":"2020","unstructured":"Sharman JP, Egyed M, Jurczak W Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, Phase III trial. Lancet 395(10232), 1278\u20131291 (2020).","journal-title":"Lancet"},{"key":"e_1_3_10_9_2","unstructured":"Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for Chronic Lymphocytic Leukemia\/Small Lymphocytic Lymphoma V.1.2025. \u00a9 National Comprehensive Cancer Network Inc. (2024). All rights reserved. Accessed [November 28 2024]. To view the most recent and complete version of the guideline go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content use or application and disclaims any responsibility for their application or use in any way."},{"key":"e_1_3_10_10_2","volume-title":"Prescribing Information","author":"IMBRUVICA (ibrutinib)","year":"2020","unstructured":"IMBRUVICA (ibrutinib). Prescribing Information. 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Leukemia 33(4), 969\u2013980 (2019).","journal-title":"Leukemia"},{"issue":"1","key":"e_1_3_10_12_2","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S1470-2045(18)30788-5","article-title":"Ibrutinib plus obinutuzumab versus chlorambucil plus obinutuzumab in first-line treatment of chronic lymphocytic leukaemia (iLLUMINATE): a multicentre, randomised, open-label, Phase III trial","volume":"20","author":"Moreno C","year":"2019","unstructured":"Moreno C, Greil R, Demirkan F Ibrutinib plus obinutuzumab versus chlorambucil plus obinutuzumab in first-line treatment of chronic lymphocytic leukaemia (iLLUMINATE): a multicentre, randomised, open-label, Phase III trial. Lancet Oncol. 20(1), 43\u201356 (2019).","journal-title":"Lancet Oncol."},{"issue":"5","key":"e_1_3_10_13_2","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1056\/NEJMoa1817073","article-title":"Ibrutinib-rituximab or chemoimmunotherapy for chronic lymphocytic leukemia","volume":"381","author":"Shanafelt TD","year":"2019","unstructured":"Shanafelt TD, Wang XV, Kay NE Ibrutinib-rituximab or chemoimmunotherapy for chronic lymphocytic leukemia. N. Engl. J. Med. 381(5), 432\u2013443 (2019).","journal-title":"N. Engl. J. Med."},{"issue":"26","key":"e_1_3_10_14_2","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1056\/NEJMoa1812836","article-title":"Ibrutinib regimens versus chemoimmunotherapy in older patients with untreated CLL","volume":"379","author":"Woyach JA","year":"2018","unstructured":"Woyach JA, Ruppert AS, Heerema NA Ibrutinib regimens versus chemoimmunotherapy in older patients with untreated CLL. N. Engl. J. 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Oncol."},{"issue":"1","key":"e_1_3_10_16_2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2217\/fon-2023-0436","article-title":"Time to next treatment in patients with chronic lymphocytic leukemia initiating first-line ibrutinib or acalabrutinib","volume":"20","author":"Jacobs R","year":"2024","unstructured":"Jacobs R, Lu X, Emond B Time to next treatment in patients with chronic lymphocytic leukemia initiating first-line ibrutinib or acalabrutinib. 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Cancer Ther."},{"issue":"5","key":"e_1_3_10_19_2","first-page":"430","article-title":"Costs and health care resource utilization among Medicare beneficiaries diagnosed with chronic lymphocytic leukemia","volume":"30","author":"Lee T-Y","year":"2024","unstructured":"Lee T-Y, Johnson A, Cooke CE Costs and health care resource utilization among Medicare beneficiaries diagnosed with chronic lymphocytic leukemia. J. Manag. Care Spec. Pharm. 30(5), 430\u2013440 (2024).","journal-title":"J. Manag. Care Spec. Pharm."},{"key":"e_1_3_10_20_2","unstructured":"Raymakers AJN Kesselheim AS Rome BN. Medicare price negotiation: the example of ibrutinib. (2023). Available from: https:\/\/www.healthaffairs.org\/content\/forefront\/medicare-price-negotiation-under-inflation-reduction-act-example-ibrutinib"},{"key":"e_1_3_10_21_2","unstructured":"US Department of Veterans Affairs. Ways Veterans differ from the general population April 15 2025. 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Epidemiol."},{"issue":"7","key":"e_1_3_10_30_2","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/00005650-200207000-00002","article-title":"VA community-based outpatient clinics: access and utilization performance measures","volume":"40","author":"Fortney JC","year":"2002","unstructured":"Fortney JC, Borowsky SJ, Hedeen AN VA community-based outpatient clinics: access and utilization performance measures. Med. Care 40(7), 561\u2013569 (2002).","journal-title":"Med. Care"},{"issue":"12","key":"e_1_3_10_31_2","doi-asserted-by":"crossref","first-page":"S188","DOI":"10.1016\/j.jval.2023.09.959","article-title":"EE694 Evaluation of healthcare resource utilization and cost among first-line patients receiving ibrutinib vs acalabrutinib for chronic lymphocytic leukemia\/small lymphocytic lymphoma (CLL\/SLL): a commercial claims database analysis","volume":"26","author":"Muluneh B","year":"2023","unstructured":"Muluneh B, He J, Ding Z EE694 Evaluation of healthcare resource utilization and cost among first-line patients receiving ibrutinib vs acalabrutinib for chronic lymphocytic leukemia\/small lymphocytic lymphoma (CLL\/SLL): a commercial claims database analysis. Value Health 26(12), S188 (2023).","journal-title":"Value Health"},{"key":"e_1_3_10_32_2","doi-asserted-by":"publisher","DOI":"10.57264\/cer-2024-0210"},{"key":"e_1_3_10_33_2","volume-title":"Presented at the 12Th Annual Meeting of the Society of Hematologic Oncology (SOHO 2024)","author":"Ravelo A","year":"2024","unstructured":"Ravelo A, Patel A, To TM. Real-world healthcare costs among patients with chronic lymphocytic leukemia receiving first-line treatment with venetoclax+ obinutuzumab versus bruton's tyrosine kinase inhibitors. Presented at the 12Th Annual Meeting of the Society of Hematologic Oncology (SOHO 2024). TX, USA, 4-7 September 2024 (2024)."},{"issue":"1","key":"e_1_3_10_34_2","doi-asserted-by":"crossref","first-page":"4757","DOI":"10.1182\/blood-2018-99-118640","article-title":"Cost-effectiveness comparison between ibrutinib, chemotherapy, and chemoimmunotherapy in front-line treatment of chronic lymphocytic leukemia (CLL)","volume":"132","author":"Nabhan C","year":"2018","unstructured":"Nabhan C, Nero D, Lee CH Cost-effectiveness comparison between ibrutinib, chemotherapy, and chemoimmunotherapy in front-line treatment of chronic lymphocytic leukemia (CLL). Blood 132(Suppl. 1), 4757 (2018).","journal-title":"Blood"},{"issue":"12","key":"e_1_3_10_35_2","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1080\/03007995.2020.1835851","article-title":"Healthcare resource utilization and costs associated with first-line ibrutinib compared to chemoimmunotherapy treatment among Medicare beneficiaries with chronic lymphocytic leukemia","volume":"36","author":"Huang Q","year":"2020","unstructured":"Huang Q, Emond B, Lafeuille MH Healthcare resource utilization and costs associated with first-line ibrutinib compared to chemoimmunotherapy treatment among Medicare beneficiaries with chronic lymphocytic leukemia. Curr. Med. Res. Opin. 36(12), 2009\u20132018 (2020).","journal-title":"Curr. Med. Res. Opin."},{"issue":"2","key":"e_1_3_10_36_2","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1001\/jamaoncol.2022.5805","article-title":"Prescription drug provisions in the Inflation Reduction Act: any relief of financial hardship for patients with cancer?","volume":"9","author":"Shih Y-CT","year":"2023","unstructured":"Shih Y-CT, Yabroff KR, Bradley CJ. Prescription drug provisions in the Inflation Reduction Act: any relief of financial hardship for patients with cancer? JAMA Oncol. 9(2), 165\u2013167 (2023).","journal-title":"JAMA Oncol."}],"container-title":["Journal of Comparative Effectiveness Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/becarispublishing.com\/doi\/pdf\/10.57264\/cer-2025-0084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:14:36Z","timestamp":1761905676000},"score":1,"resource":{"primary":{"URL":"https:\/\/becarispublishing.com\/doi\/10.57264\/cer-2025-0084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":34,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.57264\/cer-2025-0084"],"URL":"https:\/\/doi.org\/10.57264\/cer-2025-0084","relation":{},"ISSN":["2042-6305","2042-6313"],"issn-type":[{"type":"print","value":"2042-6305"},{"type":"electronic","value":"2042-6313"}],"subject":[],"published":{"date-parts":[[2025,11]]},"article-number":"e250084"}}