Supplementary data: Healthcare cost comparison between first-line ibrutinib and acalabrutinib in chronic lymphocytic leukemia patients in the Veterans Affairs

These are peer-reviewed supplementary materials for the article 'Healthcare cost comparison between first-line ibrutinib and acalabrutinib in chronic lymphocytic leukemia patients in the Veterans Affairs' published in the Journal of Comparative Effectiveness Research.Supplemental Table 1: Administrative codes for comorbiditiesAim: Bruton’s tyrosine kinase inhibitors (BTKis), including ibrutinib and acalabrutinib, transformed the treatment landscape of chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) by improving outcomes compared with chemoimmunotherapy. Real-world economic comparisons between BTKis are needed in diverse populations. This study aimed to compare healthcare costs in the Veterans Health Administration (VHA) among patients with CLL/SLL treated with, and remaining persistent on, first-line (1L) ibrutinib versus acalabrutinib monotherapy for 12 months. Materials & methods: This retrospective study used VHA electronic medical record data from January 2006 to July 2024. Eligible patients initiated 1L ibrutinib or acalabrutinib monotherapy on or after November 2019 and remained on continuous treatment for ≥12 months. All-cause and CLL/SLL-related costs were assessed over 12 months of follow-up. Generalized linear models were used to estimate adjusted costs and compare differences between treatment cohorts. Results: A total of 1059 patients were included (ibrutinib: n = 732; acalabrutinib: n = 327). During the 12-month follow-up of continuous 1L treatment, the annual adjusted all-cause total healthcare cost difference between ibrutinib and acalabrutinib was -$2422 (p = 0.46) (adjusted medical cost difference: $5259, p = 0.03; adjusted pharmacy cost difference: -$5886, p = 0.02). The annual adjusted CLL/SLL-related total healthcare cost difference between ibrutinib and acalabrutinib was -$3793 (p = 0.15) (adjustedmedical cost difference: $2085, p = 0.05; adjusted pharmacy cost difference: -$5860, p = 0.02). Conclusion: Among VHA patientswith CLL/SLL who initiated and remained on treatment with 1L BTKi monotherapy for 12 months, annual all-cause and CLL/SLL-related total healthcare costs were similar between ibrutinib and acalabrutinib. Pharmacy costs were lower for ibrutinib, while medical costs were lower for acalabrutinib, resulting in overall comparable total costs.

本内容为发表于《比较效果研究杂志》（Journal of Comparative Effectiveness Research）的论文《退伍军人医疗体系中慢性淋巴细胞白血病患者一线伊布替尼与阿卡替尼的医疗成本对比》（Healthcare cost comparison between first-line ibrutinib and acalabrutinib in chronic lymphocytic leukemia patients in the Veterans Affairs）的同行评议补充材料。
补充表1：合并症行政编码

研究目的：布鲁顿酪氨酸激酶抑制剂（Bruton’s tyrosine kinase inhibitors, BTKis），包括伊布替尼与阿卡替尼，相较于化学免疫疗法，通过改善患者结局重塑了慢性淋巴细胞白血病（chronic lymphocytic leukemia, CLL）与小淋巴细胞淋巴瘤（small lymphocytic lymphoma, SLL）的治疗格局。目前亟需在多样化人群中开展BTKis的真实世界经济对比研究。本研究旨在对比退伍军人健康管理局（Veterans Health Administration, VHA）体系内，持续接受一线（1L）伊布替尼或阿卡替尼单药治疗满12个月的CLL/SLL患者的医疗成本。

材料与方法：本回顾性研究使用2006年1月至2024年7月的VHA电子病历数据。纳入患者需于2019年11月及以后启动一线伊布替尼或阿卡替尼单药治疗，且持续接受治疗≥12个月。在12个月的随访期内，评估全因医疗成本及CLL/SLL相关医疗成本。采用广义线性模型估算校正后的医疗成本，并对比两组治疗队列的成本差异。

研究结果：最终共纳入1059例患者（伊布替尼组：n=732；阿卡替尼组：n=327）。在持续一线治疗的12个月随访期内，伊布替尼与阿卡替尼的年度校正后全因总医疗成本差值为-$2422（p=0.46）；其中校正后医疗成本差值为$5259（p=0.03），校正后药品成本差值为-$5886（p=0.02）。伊布替尼与阿卡替尼的年度校正后CLL/SLL相关总医疗成本差值为-$3793（p=0.15）；其中校正后医疗成本差值为$2085（p=0.05），校正后药品成本差值为-$5860（p=0.02）。

研究结论：在VHA体系内启动并持续接受一线BTKi单药治疗满12个月的CLL/SLL患者中，伊布替尼与阿卡替尼的年度全因及CLL/SLL相关总医疗成本相当。伊布替尼的药品成本更低，而阿卡替尼的医疗成本更低，最终两组总医疗成本无显著差异。