Cost, Personnel Time Spent on Adverse Effect Management May Assist Therapy Selection in CLL

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

Investigators found that time and costs associated with managing adverse effects (AEs) for patients with chronic lymphocytic leukemia (CLL) treated with acalabrutinib (Calquence), ibrutinib (Imbruvica), or venetoclax (Venclexta) could potentially lead to better decision making regarding which therapy to choose for a given patient, according to a study presented at the 2021 American Society of Hematology Annual Meeting.

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

“Findings from this study underscore the importance of taking into account the time and personal costs related to AE management when deciding among novel agents,” Hetalkumari Patel, PharmD, BCOP, lead author of the study, said during the presentation.

A total of 49 health care practitioners were evaluated for this study, of whom 36 reported managing 1 or more AEs over the study period with 13 (36.1%) being oncologists, 13 (36.1%) registered nurses, 5 (13.9%) pharmacists, 3 (8.3%) nurse practitioners, and 2 (5.6%) physician assistants. Out of 421 patients, 108 (26%) had received acalabrutinib, 186 (44%) were treated with ibrutinib, and 129 (31%) had venetoclax in any line of therapy. Within the last month, treatment with each corresponding agent occurred in a mean of 8.9 (SD, 9.6), 11.5 (SD, 10.1), and 7.9 patients (SD, 6.9), respectively. Practices were most frequently in urbanized areas (n = 18), followed by urban clusters (n = 17) and rural areas (n = 15).

A mean of 55.5 (SD, 41.7) healthcare clinicians (median, 31.0) were found across the different practices analyzed. Additionally, a mean of 12.4 days (SD, 13.8) were spent managing AEs (median, 6.0).

Patient characteristics overall included a median of 1.6 days (SD, 1.0) of AE management and 2.6 AE activities (SD, 2.4). Patients had a median age of 67.3 years and a majority (58.9%) were male. A total of 30 patients (7.1%) experienced grade 3 or higher AEs.

Overall, oncologists managed AEs most frequently compared with 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, corresponding rates were 70.3%, 21.0%, 7.7%, and 1.1%.

“The smaller 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 study authors. “This is further evidenced by the fact that the most common AE among patients with acalabrutinib was headache vs thrombocytopenia and anemia for ibrutinib and venetoclax, respectively.”

The mean time spent per AE in minutes in the acalabrutinib group was 12.2 minutes for oncologists, 12.0 for registered nurses, 12.3 minutes for pharmacists, and 10.7 minutes for NPs/PAs. In the ibrutinib group, corresponding time spent amounted to 10.4 minutes, 8.4 minutes, 17.9 minutes, and 25.8 minutes. In the venetoclax group, those times were 11.0 minutes, 12.2 minutes, 18.2 minutes, and 12.5 minutes, respectively.

In the acalabrutinib group, mean costs for AE management by an oncologist was $33.10 vs $7.30 for registered nurses, $12.70 for pharmacists, and $9.60 for NPs/PAs. In the ibrutinib group, costs were $28.40 for oncologists, $5.10 for registered nurses, $18.40 for pharmacists, and $23.60 for NPs/PAs. In the venetoclax group, corresponding costs were $29.90, $7.40, $18.79, and $11.20.

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


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