Cost-effectiveness of zanubrutinib versus ibrutinib in the first-line treatment for patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) in China

To evaluate the cost-effectiveness of zanubrutinib compared to ibrutinib in the first-line treatment of chronic lymphocytic leukemia (CLL) / small lymphocytic lymphoma (SLL) from the perspective of the Chinese healthcare system. A three-state partitioned survival model was constructed to simulate the lifetime outcomes and costs for patients with CLL/SLL receiving first-line treatment, with a one-month model cycle length. The clinical parameters were derived from the SEQUOIA trial for zanubrutinib and the ALLIANCE and RESONATE-2 trials for ibrutinib. Costs and medical resource utilizations were derived from the national and provincial public drug prices, as well as clinical expert surveys of eight tertiary hospitals in China. Utilities were obtained from previously published literature. Incremental cost-effectiveness ratios (ICERs) were calculated based on the total costs and quality-adjusted life years (QALYs) for each treatment, with a cost-effectiveness threshold set at three times the Chinese per capita gross domestic product (GDP). Sensitivity and scenario analyses were conducted to assess the robustness of the base case analysis results. Over a lifetime horizon, the base case analysis results revealed that zanubrutinib yielded 5.14 QALYs with a total cost of US dollar (USD) 130,382, whereas ibrutinib achieved 4.69 QALYs with a total cost of USD 153,103. By saving USD 22,722 and gaining an additional 0.45 QALYs compared to ibrutinib, zanubrutinib demonstrated a dominant ICER. Sensitivity analysis results suggested that the hazard ratio (HR) of overall survival (OS) data of ibrutinib versus bendamustine plus rituximab (BR) regimen was the most sensitive parameter, and zanubrutinib had a 90.80% probability of being more cost-effective than ibrutinib at the current threshold. The scenario analysis results further supported the robustness of these findings. For the first-line treatment of CLL/SLL patients in China, zanubrutinib is likely to be more cost-effective compared to ibrutinib.