Economic analysis of zanubrutinib vs. acalabrutinib in B-cell malignancies

A recent meta-analysis by Hwang et al. provided a comprehensive comparison of adverse event (AE) profiles of zanubrutinib with acalabrutinib in patients with B-cell malignancies. Specific AEs seen more commonly with acalabrutinib than zanubrutinib included infections, atrial fibrillation, diarrhea, nausea/vomiting, headaches, cough, fatigue and pyrexia. On the other hand, hematuria, neutropenia, and hypertension were observed more frequently with zanubrutinib than with acalabrutinib [1]. Based on the AE profiles as reported by Hwang et al. and a health economic model developed from the UK’s National Health Service perspective, the costs and quality-of-life outcomes associated with the use of zanubrutinib vs. acalabrutinib were evaluated [2]. The investigators estimated the total cost of managing AEs by summing the costs of grade ≥ 3 and grade 1/2 AEs. The loss of quality-adjusted life years (QALY) for each AE was calculated by multiplying the incidence rates with the disutility weights assigned to them and their duration. Base-case, scenario and sensitivity analyses were conducted.

Cost savings & QALY benefits

In the base-case setting, considering all AEs, treatment of a hypothetical cohort of 1,000 patients with zanubrutinib instead of acalabrutinib led to cost savings of £ 599K and 3.7 QALY gains. The scenario analysis for grade ≥ 3 AEs and grade 1/2 AEs revealed similar trends for cost savings and QALY savings, with consistent results in a scenario analysis limited to AEs that were significantly different between the two drugs (Table). In both base-case and scenario analyses, the relative contribution of grade 1/2 AEs in cost savings was higher than that of grade ≥ 3 AEs, whereas QALY savings were similar among grade ≥ 3 and grade 1/2 AEs. According to the one-way sensitivity analysis, incidence rates for infections represented the most influential parameter affecting cost savings, whereas disutility associated with headache or infections on acalabrutinib treatment was the most influential parameter affecting QALYs. The results of the proba­bilistic sensitivity analysis supported the robustness of the findings.

Overall, this economic analysis demonstrated that in patients with B-cell malignancies, zanubrutinib therapy is cost-saving and associated with QALY benefits compared to acalabrutinib in terms of AE management. These results are consistent with an identical analysis conducted from a US perspective, according to which treatment of a hypothetical cohort of 1,000 patients with zanubrutinib instead of acalabrutinib resulted in cost savings of $ 124K and 3.7 QALY gains in the base-case scenario [3]. The sensitivity analysis and probabilistic sensitivity analysis confirmed the robustness of this model.

Table Scenario analyses: cost and QALY savings in hypothetical cohorts

REFERENCES

  1. Hwang S et al., Comparison of treatment-emergent adverse events of acalabrutinib and zanubrutinib in clinical trials in B-cell malignancies: A systematic review and meta-analysis. EHA 2023, ab­stract P632
  2. Munir T et al., Zanubrutinib vs. acalabrutinib in B-cell malignancies: An adverse event-based economic analysis. EHA 2014, abstract S333
  3. Munir T et al., Comparison of zanubrutinib and acalabrutinib in B-cell malignancies: An adverse event-based analysis. J Clin Oncol 2024; 42 (suppl 16; abstr e19049)

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