Andrea Visentin, MD, is , an oncologist in the Department of Medicine, Hematology Unit, at the University of Padova in Italy.

Visentin

“Choosing the best treatment sequence that allows us not only to have the best long-term remissions and the way to improve the survival of the patient, but we also have to [consider] the cost of the drugs.”

Andrea Visentin, MD, PhD, an assistant professor in the Department of Medicine, Hematology Unit, at the University of Padova, discussed the relevance of cost analysis in guiding treatment sequencing for patients with chronic lymphocytic leukemia (CLL). He emphasized that although the therapeutic advances with targeted agents such as BTK inhibitors and BCL2 inhibitors have significantly improved survival outcomes, these regimens are associated with substantial costs that place a burden on health care systems. For this reason, integrating cost-effectiveness evaluations into treatment decision-making is increasingly important, particularly in resource-limited settings, he added.

Visentin noted that the objective of treatment sequencing is not only to achieve durable remissions and improve long-term survival but also to minimize the overall economic impact. He highlighted that pharmacoeconomic modeling can provide valuable insights into how different treatment pathways may affect both patient outcomes and health care expenditure. For instance, cost models evaluating sequencing strategies suggest that initiating therapy with a BTK inhibitor such as ibrutinib (Imbruvica), followed by venetoclax (Venclexta)-based retreatment at relapse, may lower cumulative drug costs compared with other approaches while preserving clinical benefit.

Importantly, these cost considerations are not limited to the Italian health care system. Visentin explained that similar analyses could be applied in other regions, including North America, where the financial impact of prolonged targeted therapy remains a key concern. In countries such as the United States and Canada, applying comparable pharmacoeconomic models may demonstrate that sequencing strategies emphasizing time-limited venetoclax combinations in the relapsed setting reduce overall treatment expenditures without compromising efficacy.

Cost analysis should not be viewed in isolation but as a complementary tool to clinical outcomes data when developing treatment guidelines, Visentin emphasized. Optimizing sequencing requires balancing efficacy, tolerability, and patient quality of life with financial sustainability. The ultimate goal is to ensure access to effective therapies for all eligible patients while minimizing unnecessary health care costs, he continued.

Overall, Visentin underscored the importance of incorporating cost-effectiveness modeling into clinical decision-making for CLL treatment sequencing. By carefully evaluating drug costs alongside efficacy and survival outcomes, clinicians and policymakers may identify strategies that improve both patient care and health care resource allocation. This approach has the potential to support more sustainable long-term management of CLL across diverse health care systems.

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Andrea Visentin, MD, discusses the relevance of cost analysis in guiding treatment sequencing for patients with chronic lymphocytic leukemia.

Dr Visentin on the Relevance of Cost Analysis in Guiding Treatment Sequencing for CLL

Dr Visentin on the Effects of Sequencing on Treatment Cost in CLL

“In patients with high-risk features, this time-limited venetoclax-based [regimen] allowed us to decrease the cost of overall treatments by approximately 30%.”

Andrea Visentin, MD, an oncologist in the Department of Medicine, Hematology Unit, at the University of Padova, discussed findings from an Italian cost analysis of treatment sequencing in patients with chronic lymphocytic leukemia (CLL), which were presented during the 

To conduct their analysis, Visentin and his coauthors developed a partitioned survival model which included patients with CLL who had received up to 3 lines of prior therapy followed by best supportive care, he explained. The study authors then extracted drug cost data from the Italian Medicines Agency and patients were assigned to 5 health states based on progression-free survival and overall survival data from clinical trials and real-world studies, he added. They developed 14 treatment sequences for patients without high-risk features and 18 sequences for patients with disease harboring del(17p)/

Findings from the analysis showed that the overall cost of all treatments decreased for patients who received initial treatment with a fixed-duration, venetoclax (Venclexta)–based regimen, he explained. Moreover, treatment cost decreased by approximately half for patients without high-risk features who initially received ibrutinib (Imbruvica) plus venetoclax followed by retreatment with venetoclax, he said. In patients with high-risk features, beginning therapy with time-limited venetoclax decreased the overall cost of treatment by approximately 30%, he concluded.

Additional data revealed that, over 5 years, treatment sequences beginning with fixed-duration venetoclax–based regimens led to cost savings ranging from 39% to 60% compared with BTK inhibitor–based regimens in patients without high-risk features. In patients with high-risk features, this sequencing strategy led to cost savings ranging from 37% to 44% in favor of initiating treatment with fixed-duration venetoclax–based regimens. Moreover, treatment sequences starting with fixed-duration venetoclax plus obinutuzumab (Gazyva) or venetoclax plus ibrutinib led to significantly lower overall treatment costs for patients over 5- and 10-year time spans compared with those beginning with BTK inhibition that continued until disease progression.

Andrea Visentin, MD, discusses data from an Italian cost analysis of treatment sequencing in CLL.

Andrea Visentin, MD

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Dr Visentin on the Relevance of Cost Analysis in Guiding Treatment Sequencing for CLL

Dr Visentin on the Effects of Sequencing on Treatment Cost in CLL