Cost-effectiveness of zanubrutinib versus ibrutinib as first-line treatment for patients with Waldenström macroglobulinemia in China

BACKGROUND: Zanubrutinib has demonstrated superior efficacy and safety over ibrutinib for Waldenström macroglobulinemia (WM) in the phase 3 ASPEN trial, but its cost-effectiveness in China remains unknown. This study evaluated the cost-effectiveness of zanubrutinib versus ibrutinib as first-line treatment for WM from the Chinese healthcare system perspective. METHODS: A three-state partitioned survival model (progression-free, progressive disease, death) was developed over a 15-year horizon using ASPEN trial data. Survival was extrapolated using parametric models and adjusted by relative survival. Direct medical costs were sourced from Chinese databases. ICERs were calculated using a willingness-to-pay threshold of $37,849/QALY (three times China's 2023 GDP per capita). Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Zanubrutinib resulted in an incremental gain of 0.084 QALYs at a cost saving of $26,768 per patient compared with ibrutinib, yielding an ICER of -$318,719/QALY. The negative ICER indicates that zanubrutinib is both more effective and cost-saving (i.e. a dominant strategy) relative to ibrutinib. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these findings. CONCLUSION: Under current Chinese pricing and healthcare system conditions, zanubrutinib is a cost-effective and dominant alternative to ibrutinib for first-line treatment of WM.