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Publications

Journal Article Ahead of print

PubMed: 42082998 DOI: 10.1186/s12913-026-14619-7

Organizational impacts of fixed-duration therapies for the management of patients with chronic lymphocytic leukemia in Italy.

BMC Health Serv Res

Authors: Carla Rognoni, Giacomo Loseto, Antonio Cuneo, Anna Maria Frustaci, Francesca Romana Mauro, Francesco Costa, Patrizio Armeni

Affiliations

  • Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy.
  • IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.
  • Università degli Studi di Ferrara, Ferrara, Italy.
  • ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
  • Dipartimento di Medicina Traslazionale e di Precisione, Università La Sapienza, Roma, Italy.
  • Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy.

Abstract

BACKGROUND

Chronic Lymphocytic Leukemia (CLL) is a common adult leukemia characterized by the progressive accumulation of dysfunctional lymphocytes. Recently introduced fixed-duration targeted therapies for previously untreated patients have demonstrated superior efficacy compared to chemotherapy, while offering time-limited treatment that improves patient quality of life and reduces the burden on healthcare systems compared to continuous therapies. This analysis examines the organizational impact of implementing first-line, fixed-duration CLL therapies, with focus on healthcare resource allocation, costs, and patient management.

METHODS

The regimens analyzed included ibrutinib + venetoclax (I + V, oral), venetoclax + obinutuzumab (Ven-Obi, oral/infusion), bendamustine + rituximab (BR, infusion), chlorambucil + obinutuzumab (Clb-Obi, oral/infusion), and fludarabine + cyclophosphamide + rituximab (FCR, infusion). Data were defined through product characteristics, published literature, expert opinion, and standard hospital procedures for drug administration, adverse event management, and treatment duration. A questionnaire administered in four Italian centers captured organizational aspects such as healthcare personnel time, patient assessment, treatment preparation and administration, and follow-up.

RESULTS

Personnel time and costs varied substantially across regimens, with administration mode (oral vs. infusion) emerging as a key driver. Time ranged from 4,899 min (81.6 h) for BR to 8,019 min (133.7 h) for Ven-Obi. Organizational costs ranged from €3,942 (BR) to €8,631 (Ven-Obi). The all-oral I + V combination showed a lower cost profile (€5,724) than Ven-Obi and was comparable to Clb-Obi, despite additional monitoring requirements.

CONCLUSIONS

Treatment selection should balance efficacy with organizational and economic considerations. Findings highlight that oral therapies improve efficiency and patient convenience while reducing delivery costs.

MeSH

Leukemia, Lymphocytic, Chronic, B-Cell, Leukemia, Leukemia, Lymphoid, Rituximab, Therapeutics