Analysis Finds Brukinsa May Provide Costs Savings Over Imbruvica in CLL

The use of Brukinsa (zanubrutinib) instead of Imbruvica (ibrutinib) as a second-line treatment for patients with chronic lymphocytic leukemia could potentially lead to fewer adverse events and result in fewer healthcare costs, according to new analysis. This analysis, using a number-needed-to-treat (NNT) modeling method, estimated that approximately 13 of 100 patients would avoid disease progression or death over 24 months, saving about $4.7 million.

Developed by BeiGene, Brukinsa is a small molecule inhibitor of Bruton’s tyrosine kinase (BTK). BTK is an important enzyme in the B-cell receptor signaling pathway, regulating cell proliferation and cell survival in various B-cell malignancies. It is approved for several types of lymphoma: mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, marginal zone lymphoma, follicular lymphoma and Waldenström’s macroglobulinemia, a rare type of non-Hodgkin lymphoma. Global revenue for the full year 2024 was $2.6 billion, of which $2 billion was revenue in the United States.

In the analysis recently published in the Journal of Managed Care & Specialty Pharmacy, researchers used a number-needed-to-treat model to compare the use of Brukinsa and Imbruvica for disease progression or death and medication and costs.

Number needed to treat (NNT) is a statistical measure of clinical effectiveness. It is a projection of clinical trial results looking forward to a larger population. It estimates the number of people who would need to be treated to have an impact on one patient.

In this BeiGene-sponsored economic analysis of Brukinsa and Imbruvica, researchers conducted a base-case analysis, which looks at the most likely set of assumptions about a given situation to arrive at the most likely outcome.

Researchers wanted to find out how many people would need to be treated over three time points — 12, 24 and 36 months — for one patient to have an event such as progression of disease or death for Brukinsa compared with Imbruvica. They analyzed the endpoint used from the ALPINE clinical trial, which compared the progression-free survival of both drugs in relapsed or refractory chronic lymphocytic leukemia. In the final analysis of the ALPINE trial, progression-free survival, the primary efficacy endpoint in this study, for patients treated with Brukinsa was maintained longer than for Imbruvica.

Researchers from the JMCP study used progression-free survival between the treatment group and the control group to determine an absolute risk reduction, which is necessary for the analysis of the number needed to treat.

Based on a hypothetical scenario of a clinical practice of 100 patients treated with Brukinsa instead of ibrutinib, the model estimated that approximately 13 patients would avoid disease progression or death over 24 months. The model estimated that for every 8 patients treated with Brukinsa, 1 event of progression or death was avoided compared with using ibrutinib.

Researchers assumed a payer mix of 40% commercial and 60% Medicare, similar to the patient population in the study. Researchers used drug costs from the 2024 RED Book, which were $15,066.00 for a 30-day supply of Brukinsa and $16,391.63 for a 30-day supply of Imbruvica. Adverse event-related costs were estimated to be $6,685 for Brukinsa and $6,812 for Imbruvica.

Based on this analysis, the total costs per patient treated with Brukinsa were $399,928, and costs for Imbruvica were $447,059. The clinical practice in this scenario could potentially realize a substantial cost savings of $4.7 million over 24 months, and cost savings are projected to increase to $5.8 million over 36 months.

One limitation, the researchers said, was that the ALPINE study did not have data on medical resource utilization, and medical resource information was not available. Researchers instead used two previous studies — one published in The Oncologist in September 2019 and another in Advances in Therapy from May 2020 — to inform their analysis of healthcare costs in chronic lymphocytic leukemia.