Dr Munir on Cost and QOL Outcomes With Zanubrutinib vs Acalabrutinib in B-Cell Malignancies

Talha Munir, MBChB, PhD, consultant, clinical hematology, Leeds Teaching Hospital NHS Trust, discusses key findings from an adverse effect (AE)–based economic analysis of zanubrutinib (Brukinsa) vs acalabrutinib (Calquence) in patients with B-cell malignancies from the United Kingdom.

Previously reported findings from a meta-analysis presented at the 2023 EHA Congress showed that both acalabrutinib and zanubrutinib were associated with improved toxicity profiles compared with ibrutinib (Imbruvica). Acalabrutinib was associated with higher rates of infections, atrial fibrillation, diarrhea, nausea/vomiting, headaches, cough, fatigue, and pyrexia vs zanubrutinib. Conversely, higher rates of hematuria, neutropenia, and hypertension were observed with zanubrutinib compared with acalabrutinib.

Based on these AE profiles, Munir and colleagues sought to further analyze the cost and quality-of-life (QOL) outcomes for the 2 agents, Munir details. Findings presented at the 2024 EHA Congress showed that treatment with zanubrutinib was associated with cost savings and quality-adjusted life year (QALY) benefits vs treatment with acalabrutinib in patients with B-cell malignancies, he reports.

In their base case analysis of a hypothetical cohort of 1000 patients, treatment with zanubrutinib resulted in substantial cost savings and QALY benefits compared with acalabrutinib. Specifically, using zanubrutinib instead of acalabrutinib led to a cost savings of £599,000 and a QALY gain of 3.7. The cost of managing AEs associated with zanubrutinib was £2,331,858 vs £2,930,429 for acalabrutinib. The QALYs lost due to AEs were 9.4 for zanubrutinib and 13.1 for acalabrutinib, underscoring a significant QOL benefit with zanubrutinib.

In scenario analyses focusing on different severities of AEs (grade 3 or higher vs grade 1/2) and analyses with statistically significant differences between the 2 drugs, zanubrutinib was consistently associated with cost savings and QALY benefits across these categories. Notably, the cost savings were more influenced by grade 1/2 AEs (64% in base case, 65% in scenario) compared with grade 3 or higher AEs (36% in base case, 35% in scenario). QALY savings were also substantial across both severity categories, with slightly higher impacts seen with grade 1/2 AEs (51% in base case, 54% in scenario) compared with grade 3 or higher AEs (49% in base case, 46% in scenario).

A one-way sensitivity analysis highlighted that the incidence rate of infections was the most influential factor affecting cost savings, indicating that reducing infection rates could further enhance economic benefits with zanubrutinib. Similarly, parameters related to the disutility of specific AEs, such as headaches and infections associated with acalabrutinib, significantly influenced QALY outcomes.

Overall, these findings indicate that treatment with zanubrutinib offers potential clinical advantages with the drug’s AE profile andtranslates into substantial economic benefits and improved QOL outcomes compared with acalabrutinib in the management of B-cell malignancies, he says. Munir concludes by stating that a similar analysis using a United States–based cost system has been performed, and results were presented at the 2024 ASCO Annual Meeting.