Cost-effectiveness analysis of ibrutinib plus venetoclax for relapsed or refractory mantle cell lymphoma in China and the United States

Background The SYMPATICO trial demonstrated that ibrutinib combined with venetoclax significantly improved progression-free survival in patients with relapsed or refractory (R/R) mantle cell lymphoma (MCL). This study evaluated the cost-effectiveness of the combination of ibrutinib–venetoclax for R/R MCL from the healthcare perspectives of China and the United States (US). Methods A partitioned survival model with a 35-year simulation time horizon was developed to compare the cost-effectiveness of ibrutinib–venetoclax versus ibrutinib–placebo. Primary outcomes included total costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The robustness of the model was evaluated through one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA). Results Base-case analysis showed that the ICER of ibrutinib–venetoclax versus ibrutinib–placebo was $128,183.93/QALY in China, which was significantly higher than the willingness-to-pay (WTP) threshold of $40,334/QALY. It was still not cost-effective below the $150,000/QALY WTP threshold in the US, with an ICER of $951,082.87/QALY. OWSA demonstrated the robustness of the model. PSA showed that ibrutinib–venetoclax had a 0% probability of being cost-effective under the current WTP thresholds in China and the US. Price reduction analysis indicated that in China, reducing the price of venetoclax to 20% of its original cost could achieve cost-effectiveness with a 60.80% probability. In the US, a combined price reduction of ibrutinib and venetoclax to 22.53% of their original costs is necessary to achieve a 50% probability of cost-effectiveness. Conclusion Ibrutinib-venetoclax is unlikely to be cost-effective versus ibrutinib–placebo for R/R MCL in both China and the US.