Economic Burden of Chronic Lymphocytic Leukaemia in Australia.

BACKGROUND: The treatment landscape for chronic lymphocytic leukaemia (CLL) has transformed over the past decade. This study aimed to estimate the healthcare costs and health burden associated with CLL in Australia. METHODS: A Markov model was developed to simulate the lifetime healthcare costs and health outcomes associated with CLL in Australia under the CIT-only era and the current era incorporating targeted therapies. The model considered treatment initiation, switching, and long-term survival. Clinical inputs were derived from Australian Cancer Database data (2009-2020) for the CIT era, while cost and utility parameters were obtained from government sources and published literature. The model ran over a 15-year horizon, reflecting the average age of CLL onset in Australia (68 years). Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Total healthcare costs were substantially higher in the targeted therapy era ($751 727 per patient) compared to the CIT era ($33 505 per patient). Drug costs, particularly continuous BTKis therapy, were the main driver ($739 960 vs. $15 359). CLL patients were estimated to accumulate 3.62 and 7.83 QALYs in the CIT and targeted therapy eras, respectively, compared to 10.56 QALYs for the general population aged 68-indicating QALY losses of 6.94 and 2.73, respectively. Life expectancy shortfalls were 6.69 and 3.21 years, respectively. Targeted therapy led to incremental gains of 4.22 QALYs and 3.47 life years. Sensitivity analysis identified that discount rate, age at onset, treatment costs, and time horizon significantly influenced incremental costs, while treatment effectiveness and quality of life in the progression-free state were key drivers of QALY gains. CONCLUSIONS: CLL imposes a significant economic burden and QALY loss. While targeted therapies offer meaningful health gains, their high cost highlights the need for strategic planning to ensure sustainable resource allocation. Policymakers should balance clinical benefit with financial impact to optimise value in cancer care.