Evidence map›Paper›PMID 27870563›Full record

ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2017

Economic Burden of Chronic Lymphocytic Leukemia in the Era of Oral Targeted Therapies in the United States.

Qiushi Chen, Nitin Jain, Turgay Ayer, William G Wierda, Christopher R Flowers, Susan M O'Brien, Michael J Keating, Hagop M Kantarjian, Jagpreet Chhatwal

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
88citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

88 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Systematic Literature Review of Economic Evaluations of Treatment Alternatives in Chronic Lymphocytic Leukemia.BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy · 2023
    Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Trial
  6. Trial
  7. Review
  8. The Market for Monoclonal Antibodies: Trends, Challenges, and Opportunities.BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy · 2026
    Article
  9. Review
  10. Article
  11. Review
  12. Observational
  13. Review
  14. Back from (BTKi) holiday.Blood advances · 2025
    Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Observational
  20. Article

28 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Qiushi ChenQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
Nitin JainQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
Turgay AyerQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
William G WierdaQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
Christopher R FlowersQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
Susan M O'BrienQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
Michael J KeatingQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
Hagop M KantarjianQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.
Jagpreet ChhatwalQiushi Chen and Turgay Ayer, Georgia Institute of Technology; Christopher R. Flowers, Emory University, Atlanta, GA; Qiushi Chen and Jagpreet Chhatwal, Massachusetts General Hospital; Jagpreet Chhatwal, Harvard Medical School, Boston, MA; Nitin Jain, William G. Wierda, Michael J. Keating, and Hagop M. Kantarjian, The University of Texas MD Anderson Cancer Center, Houston, TX; and Susan M. O'Brien, University of California Irvine Medical Center, Orange, CA.

Funding

Tissue CoreP01CA081534 · NCI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI KIPPS, THOMAS J · 2000 to 2016
$59.5M
NCI NIH HHS P01 CA081534
6 · The paper itself

Abstract

Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward. A comparator scenario also was simulated where CIT remained the standard of care throughout. Disease progression and survival parameters for each therapy were based on published clinical trials. Results The number of people living with CLL in the United States is projected to increase from 128,000 in 2011 to 199,000 by 2025 (55% increase) due to improved survival; meanwhile, the annual cost of CLL management will increase from $0.74 billion to $5.13 billion (590% increase). The per-patient lifetime cost of CLL treatment will increase from $147,000 to $604,000 (310% increase) as oral targeted therapies become the first-line treatment. For patients enrolled in Medicare, the corresponding total out-of-pocket cost will increase from $9,200 to $57,000 (520% increase). Compared with the CIT scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life-year. Conclusion The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients.

Indexed as

Cost-Benefit AnalysisCost of IllnessCosts and Cost AnalysisHumansLeukemia, Lymphocytic, Chronic, B-CellModels, TheoreticalQuality of LifeUnited States

Identifiers

PMID27870563
PMCPMC5559889

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.