Cost and staff time spent managing side effects can make treatment selection in CLL easier

A study presented at ASH 2021 found that the costs and time spent managing side effects varied significantly in patients with chronic lymphocytic leukemia who were treated with acalabrutinib, ibrutinib, and venetoclax.

The researchers found that the time and costs associated with managing adverse reactions (AEs) in patients with chronic lymphocytic leukemia (CLL) treated with acalabrutinib (Calquence), ibrutinib (Imbruvica) or venetoclax (Venclexta) could potentially lead to to better decision-making about which treatment to choose for a given patient, according to a study presented at the 2021 annual meeting of the American Society of Hematology.

During the 2-month study period, the time spent managing AEs totaled 13,008 minutes for all 3 treatments (229 for acalabrutinib, 500 for ibrutinib, and 377 for venetoclax). The overall personnel cost per EA management was $ 22.8 (standard deviation, $ 16.5), after applying labor costs to the average time spent on each. The lowest costs were noted in the acalabrutinib group ($ 19.9; SD, $ 15.8), potentially due to a lower proportion of oncologists managing AEs associated with this treatment.

“The results of this study underscore the importance of taking into account the time and personal costs of managing AEs when choosing new agents,” said Hetalkumari Patel, PharmD, BCOP, lead author of the study, during the presentation.

A total of 49 healthcare practitioners were assessed for this study, of whom 36 reported managing 1 or more AEs during the study period, of whom 13 (36.1%) were oncologists, 13 ( 36.1%) registered nurses, 5 (13.9%) pharmacists, 3 (8.3%) nurse practitioners and 2 (5.6%) physician assistants. Of 421 patients, 108 (26%) had received acalabrutinib, 186 (44%) were treated with ibrutinib and 129 (31%) had received venetoclax in any line of treatment. During the past month, treatment with each corresponding agent occurred in an average of 8.9 (SD, 9.6), 11.5 (SD, 10.1), and 7.9 patients (SD, 6 , 9), respectively. The practices were most often found in urbanized areas (n = 18), followed by urban clusters (n = 17) and rural areas (n = 15).

An average of 55.5 (SD, 41.7) health clinicians (median, 31.0) were found in the different practices analyzed. Additionally, an average of 12.4 days (SD, 13.8) were spent managing AEs (median, 6.0).

Overall patient characteristics included a median of 1.6 days (SD, 1.0) of EA management and 2.6 EA activities (SD, 2.4). The patients had a median age of 67.3 years and a majority (58.9%) were men. A total of 30 patients (7.1%) experienced AEs of grade 3 or greater.

Overall, oncologists managed ARs most often compared to registered nurses, pharmacists, and nurse practitioners / physician assistants (NPs / PAs). In the acalabrutinib group, 46.7% of AEs were managed by oncologists, 41.9% were managed by registered nurses, 8.3% were managed by pharmacists, and 3.1% were managed by NPs / PAs. In the ibrutinib group, 67.8% of AEs were managed by oncologists, 16.4% by registered nurses, 12.2% by pharmacists and 3.6% by NPs / PAs. In the venetoclax group, the corresponding rates were 70.3%, 21.0%, 7.7% and 1.1%.

“The lower proportion of oncologists managing AEs for patients treated with acalabrutinib compared to ibrutinib or venetoclax suggests differences in the type and complexity of AEs experienced by patients on acalabrutinib,” wrote the authors of the study. “This is further demonstrated by the fact that the most common AE in patients with acalabrutinib was headache versus thrombocytopenia and anemia for ibrutinib and venetoclax, respectively. “

The average time spent per AE in minutes in the acalabrutinib group was 12.2 minutes for oncologists, 12.0 for RNs, 12.3 minutes for pharmacists, and 10.7 minutes for NP / PAs. In the ibrutinib group, the corresponding time spent was 10.4 minutes, 8.4 minutes, 17.9 minutes and 25.8 minutes. In the venetoclax group, these times were 11.0 minutes, 12.2 minutes, 18.2 minutes and 12.5 minutes, respectively.

In the acalabrutinib group, the average costs of managing AEs by an oncologist were $ 33.10 versus $ 7.30 for RNs, $ 12.70 for pharmacists and $ 9.60 for NPs / AM. In the ibrutinib group, the costs were $ 28.40 for oncologists, $ 5.10 for RNs, $ 18.40 for pharmacists, and $ 23.60 for NPs / PAs. In the venetoclax group, the corresponding costs were $ 29.90, $ 7.40, $ 18.79, and $ 11.20.

“Further research is needed to confirm the differences observed in this study regarding the types of AEs and healthcare practitioners dealing with AEs, stratified by treatment, for patients with CLL,” Patel concluded.


Patel H, Wahlstrom S, DerSarkissian M, et al. Time and personnel costs associated with the management of adverse events (AEs) in patients with chronic lymphocytic leukemia (CLL) treated with acalabrutinib, ibrutinib, or venetoclax. Presented at the 63rd Annual Meeting 2021 of the American Society of Hematology. December 11-14, 2021. Atlanta, Georgia. Summary 2999.

Martin E. Berry