Shanafelt Tait D, Borah Bijan J, Finnes Heidi D, Chaffee Kari G, Ding Wei, Leis Jose F, Chanan-Khan Asher A, Parikh Sameer A, Slager Susan L, Kay Neil E, Call Tim G
Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; and Mayo Clinic, Jacksonville, FL
Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; and Mayo Clinic, Jacksonville, FL.
J Oncol Pract. 2015 May;11(3):252-8. doi: 10.1200/JOP.2014.002469. Epub 2015 Mar 24.
To evaluate the impact of approval of ibrutinib and idelalisib on pharmaceutical costs in the treatment of chronic lymphocytic leukemia (CLL) at the societal level and assess individual out-of-pocket costs under Medicare Part D.
Average wholesale price of commonly used CLL treatment regimens was ascertained from national registries. Using the population of Olmsted County, Minnesota, we identified the proportion of patients with newly diagnosed CLL who experience progression to the point of requiring treatment. Using these data, total pharmaceutical cost over a 10-year period after diagnosis was estimated for a hypothetic cohort of 100 newly diagnosed patients under three scenarios: before approval of ibrutinib and idelalisib (historical scenario), after approval of ibrutinib and idelalisib as salvage therapy (current scenarios A and B), and assuming use of ibrutinib as first-line treatment (potential future scenario).
Estimated 10-year pharmaceutical costs for 100 newly diagnosed patients were as follows: $4,565,929 (approximately $45,659 per newly diagnosed patient and $157,446 per treated patient) for the historical scenario, $7,794,843 (approximately $77,948 per newly diagnosed patient and $268,788 per treated patient) for current scenario A, $6,309,162 (approximately $63,092 per newly diagnosed patient and $217,557 per treated patient) for current scenario B, and $16,414,055 (approximately $164,141 per newly diagnosed patient and $566,002 per treated patient) for the potential future scenario. Total out-of-pocket cost for 100 patients with newly diagnosed CLL under Medicare Part D increased from $9,426 under the historical scenario (approximately $325 per treated patient) to $363,830 and $255,051 under current scenarios A and B (approximately $8,800 to $12,500 per treated patient) and to $1,031,367 (approximately $35,564 per treated patient) under the future scenario.
Although ibrutinib and idelalisib are profound treatment advances, they will dramatically increase individual out-of-pocket and societal costs of caring for patients with CLL. These cost considerations may undermine the potential promise of these agents by limiting access and reducing adherence.
评估依鲁替尼和idelalisib获批对社会层面慢性淋巴细胞白血病（CLL）治疗药物成本的影响，并评估医疗保险D部分下的个人自付费用。
从国家登记处确定常用CLL治疗方案的平均批发价格。利用明尼苏达州奥尔姆斯特德县的人口数据，我们确定了新诊断的CLL患者进展到需要治疗阶段的比例。利用这些数据，在三种情况下估计了100名新诊断患者诊断后10年的总药物成本：依鲁替尼和idelalisib获批前（历史情况）、依鲁替尼和idelalisib获批作为挽救疗法后（当前情况A和B），以及假设使用依鲁替尼作为一线治疗（潜在未来情况）。
100名新诊断患者的估计10年药物成本如下：历史情况为4,565,929美元（每名新诊断患者约45,659美元，每名接受治疗的患者约157,446美元），当前情况A为7,794,843美元（每名新诊断患者约77,948美元，每名接受治疗的患者约268,788美元），当前情况B为6,309,162美元（每名新诊断患者约63,092美元，每名接受治疗的患者约217,557美元），潜在未来情况为16,414,055美元（每名新诊断患者约164,141美元，每名接受治疗的患者约566,002美元）。医疗保险D部分下100名新诊断CLL患者的总自付费用从历史情况下的9,426美元（每名接受治疗的患者约325美元）增加到当前情况A和B下的363,830美元和255,051美元（每名接受治疗的患者约8,800美元至12,500美元），以及未来情况下的1,031,367美元（每名接受治疗的患者约35,564美元）。
尽管依鲁替尼和idelalisib是重大的治疗进展，但它们将大幅增加CLL患者护理的个人自付费用和社会成本。这些成本考虑因素可能会通过限制可及性和降低依从性来削弱这些药物的潜在前景。
