CLINICAL AND PHARMACOECONOMIC ANALYSIS OF FIRST- AND SECOND-LINE THERAPY WITH BRUTON TYRO-SINE KINASE INHIBITORS FOR CHRONICLYMPHOCYTIC LEUKEMIA IN KAZAKHSTAN

L. Turgunova, A A Klodzinsky, Maria Butyugina, I. Pivovarova, Vadim Kemaykin, Azat Baglanovich Karabekov, M. Khudaibergenova

2026

Closed access Metadata (CSL-JSON)
DOI 10.52532/2663-4864-2025-4-78-595
Data confidence 70 medium
How this score is calculated

It is built from checkable properties of the record itself: whether the article has a DOI, how many independent sources confirmed its data, whether the required fields are filled in, and how recent the latest confirmation is. Disagreement between sources and a missing identifier lower it. A value of 80 or above means the record was published without further checking; 60 to 79 means it is published at reduced confidence, with a manual check advisable. A record verified by an editor by hand is never pushed below 90 by a recalculation. This scores our data about the article, not the article itself.

Abstract

Relevance: Bruton tyrosine kinase inhibitors (BTKis) have significantly improved outcomes in chronic lymphocytic leukemia (CLL), but their high cost and differing safety profiles warrant phar-macoeconomic evaluation. The study aimed to compare the costs and effectiveness of long-term acalabrutinib versus ibrutinib therapy in first-line and second-line CLL in Kazakhstan and to assess the budget impact of treatment choice. Methods: A cost-effectiveness analysis was conducted using a three-state semi-Markov model (pro-gression-free, progressed disease, death) over a 20-year horizon for first-line and a 10-year horizon for second-line. Efficacy inputs were derived from key trials (ELEVATE-TN, RESONATE-2, EL-EVATE-RR). Direct medical costs included drug costs (2024 prices) and management of adverse events (AEs). Effectiveness was measured in quality-adjusted life years (QALYs), accounting for utility loss from serious AEs. Sensitivity analyses and a budget impact analysis were performed. Results: In the base case, acalabrutinib and ibrutinib had equivalent anti-leukemic efficacy (median PFS ~8-9 years in 1st line; 38.4 months in 2nd line; no difference in OS). Due to a more favorable safety profile, acalabrutinib yielded higher QALYs than ibrutinib: +0.48 QALY per patient in the first line and +0.13 QALY in the second line. Total pre-progression costs per patient were lower with acalabrutinib by KZT 3.08 million (-0.93%) in the first line and KZT 1.54 million (-1.16%) in the second line, mainly due to reduced AE management costs. Incremental analysis indicated that acalabrutinib dominates ibrutinib (greater QALYs at lower cost), with cost savings of KZT 6.40-11.85 million per QALY gained. Expanding acalabrutinib use to 85% of high-risk patients (TP53 mutation/17p deletion) could reduce total budget expenditure by ~0.23% over 3 years. Conclusions: The semi-Markov model results showed that acalabrutinib and ibrutinib are equally effective in treating patients. However, the acalabrutinib strategy is better because it costs less over-all and yields a higher QALY, driven by lower side-effect management costs. These findings support the rationale for broader use of acalabrutinib, particularly in high-risk patients, to optimize outcomes and resource utilization.