Zanubrutinib May Lead to Cost Savings vs Ibrutinib in R/R CLL

Wider use of zanubrutinib (Brukinsa; BeiGene) in patients with relapsed or refractory chronic lymphocytic leukemia (R/R CLL) could improve outcomes and lower the cost of care for patients, a new analysis published in the Journal of Managed Care & Specialty Pharmacy found.¹

Zanubrutinib, a next-generation Bruton tyrosine kinase (BTK) inhibitor, was FDA approved in 2023 for patients with CLL or small lymphocytic leukemia based on findings from the phase 3 ALPINE trial (NCT03734016), which showed the therapy led to a significant improvement in progression-free survival (PFS), compared with the earlier-generation BTK inhibitor ibrutinib (HR, 0.65; 95% CI, 0.49-0.86; P = .002).²

Yet, while trials have shown that zanubrutinib can benefit many patients with relapsed or R/R CLL, the economic case for the therapy has not yet been thoroughly investigated, the authors of the new study noted.¹

In a 100-patient clinical practice scenario, cost savings with zanubrutinib vs ibrutinib would amount to $4.7 million. | Image credit: sovova - stock.adobe.com

To better understand the financial impact of using zanubrutinib vs ibrutinib, the researchers used clinical efficacy data from the ALPINE trial, using 24-month PFS for the base-case analysis. They then calculated the cost impact of the number needed to treat (NNT) to avoid 1 patient progression or death, as well as costs associated with direct treatment, adverse event management, medical resource utilization, and subsequent treatment.

The base-case analysis found that treating 8 patients with zanubrutinib instead of ibrutinib would prevent 1 progression or death.

“Based on a hypothetical scenario of a clinical practice of 100 patients treated with zanubrutinib instead of ibrutinib, the model estimated that approximately 13 patients would avoid disease progression or death over 24 months,” the authors wrote.

They also found that zanubrutinib led to lower costs per patient ($399,928) compared with ibrutinib ($447,059), a savings of more than $47,000 per zanubrutinib-treated patient. They noted that in their 100-patient clinical practice scenario, those cost savings would amount to $4.7 million.

Drug costs and PFS were the major drivers of the incremental cost savings in the NNT analysis. “Additionally, the scenario analysis demonstrated that these results are robust when alternative PFS definitions and time horizons are used, indicating that the findings are reliable,” the authors explained.

They added that cost savings could also be realized from the Enhancing Oncology Care model, a voluntary value-based payment structure designed by CMS to incentivize providers to improve care while lowering costs.

“Our analysis estimated that compared with ibrutinib, treating patients with R/R CLL with zanubrutinib will lead to more favorable clinical and economic outcomes over a 24-month time horizon, resulting in fewer clinical events, such as disease progression, and significant cost savings,” the authors wrote.

The study had limitations, including that PFS inputs were from specific time points rather than a parametric fitting of the survival curve. Using such time points, they noted, may not reflect the true PFS trajectory over time.

However, they said the use of multiple definitions of PFS may help overcome the limitation. They also noted that the ALPINE trial itself did not include medical resource utilization data, and direct real-world observational data are not yet available for zanubrutinib in this patient population. Instead, they used a pair of economic studies of patients with CLL to generate utilization costs.

Still, the authors said their data offer support for zanubrutinib to be considered a priority second-line or later treatment option in R/R CLL.

References

1. Chanan-Khan A, Hanna K, Xue M, et al. Number needed to treat and associated cost analysis of zanubrutinib vs ibrutinib in chronic lymphocytic leukemia. J Manag Care Spec Pharm. Published online April 10, 2025. doi:10.18553/jmcp.2025.24330
2. Brown JR, Eichhorst B, Hillmen P, et al. Zanubrutinib or ibrutinib in relapsed or refractory chronic lymphocytic leukemia. N Engl J Med. 2023;388(4):319-332. doi:10.1056/NEJMoa2211582