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 2025 EHA Congress.

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)/TP53 mutations, he noted.

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.