Cost Effectiveness of First-Line Therapies for Treatment-Naïve Chronic Lymphocytic Leukaemia in South Africa

In the South African public healthcare setting, CIT regimens (FCR and BR) represent cost-effective first-line treatment strategies for symptomatic, treatment-naïve CLL. Bendamustine-plus-rituximab emerged as the most decision-robust option under uncertainty, while FCR yielded the lowest point-estimate ICER. Among CIT regimens, FCR may be preferred in fit patients, while BR represents a more decision-robust option in older or unfit populations. Targeted therapies such as ibrutinib and VenO, despite superior clinical efficacy, are not cost effective at current prices. Substantial price reductions, generic entry, or targeted use in high-risk subgroups may improve their value and enable equitable access within South Africa's resource-constrained health system.