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

“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.