A scoping review of the cost-effectiveness of precision treatment in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a common, incurable leukemia. Precision treatment for CLL uses genetic testing to align therapeutic selection with patient characteristics. Insurers are uneven in their reimbursement of precision CLL treatment, partly due to uncertain evidence of cost-effectiveness. This review surveys the current cost-effectiveness evidence for precision CLL treatment and identifies areas for future research. We conducted a scoping review of economic evaluations of precision CLL treatments indexed in PubMed, Embase, and Web of Science and published by October 2024. Eight articles were retrieved. Studies examined heterogeneous patient populations, treatment regimens, and stratification strategies. Four studies (50%) focused on subgroups with del(17p) and/or TP53 mutations only. Three studies (38%) analyzed the costs and outcomes of both treatment and genetic testing, while 62% did not include the cost or outcomes of genetic testing. All studies obtained clinical model parameters from published trials. Five studies (63%) reported that precision CLL treatment was likely cost-effective at willingness to pay thresholds ranging from $26,489/QALY to $130,477/QALY. Future research should focus on generating real-world data, broadening the scope of analysis to include societal perspectives, and exploring distributional impacts to more effectively address the heterogeneity of precision CLL treatments when determining their cost-effectiveness.