Economic Evaluation of Bruton’s Tyrosine Kinase Inhibitors for Chronic Lymphocytic Leukaemia in South Africa

Zanubrutinib may be a cost-saving and clinically superior treatment option for both untreated and relapsed/refractory CLL compared to ibrutinib in South Africa's public healthcare system. Its dominance is driven by lower acquisition and adverse event costs, paired with favourable survival and quality-of-life outcomes. Acalabrutinib may also represent a cost-effective alternative compared to ibrutinib, providing meaningful clinical benefit at acceptable additional cost. These results support the prioritisation of zanubrutinib for public sector access and reimbursement, while highlighting acalabrutinib's value in selected patient scenarios.