Stylized graph showing upward trend of DNA strands in a hospital setting, representing the cost-effectiveness of leukemia treatment.

Navigating Leukemia Treatment: Is Blinatumomab a Cost-Effective Choice?

Nico Varela in Health & Wellness December 2025 • 4 min read.

"A closer look at the cost-effectiveness of blinatumomab versus inotuzumab for adults battling relapsed or refractory acute lymphoblastic leukemia."

Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the blood and bone marrow. When ALL returns after treatment (relapsed) or doesn't respond to initial treatment (refractory), finding the right therapy becomes critical. Blinatumomab and inotuzumab ozogamicin are two such treatments used in adults with relapsed or refractory (R/R) ALL.

The challenge for healthcare providers and patients is determining which treatment offers the best value, considering both its effectiveness and cost. This is where cost-effectiveness analysis comes in, helping to weigh the benefits against the financial burden.

This article delves into a study comparing the cost-effectiveness of blinatumomab versus inotuzumab in adult patients with R/R ALL who have undergone zero or one prior salvage therapy. By examining the incremental cost-effectiveness ratio (ICER), we aim to shed light on whether blinatumomab represents a worthwhile investment from a US payer perspective.

Blinatumomab vs. Inotuzumab: A Cost-Effectiveness Comparison

Stylized graph showing upward trend of DNA strands in a hospital setting, representing the cost-effectiveness of leukemia treatment.

The study utilized a matching-adjusted indirect treatment comparison (MAIC) of the TOWER and INO-VATE-ALL trials to estimate the ICER (cost per QALY gained) of blinatumomab compared to inotuzumab. A partitioned-survival model was employed, incorporating data from both trials, adjusted via MAIC to ensure comparable patient characteristics.

Three separate analyses were conducted to provide a comprehensive understanding:

Analysis 1: Compared inotuzumab overall survival (OS) using a MAIC-adjusted hazard ratio to blinatumomab MAIC-adjusted TOWER OS.
Analysis 2: Assessed inotuzumab and standard-of-care (SOC) OS against blinatumomab OS, applying a MAIC-adjusted hazard ratio.
Analysis 3: Performed an unanchored comparison of MAIC-adjusted blinatumomab OS from TOWER and inotuzumab OS from INO-VATE-ALL.

The same event-free survival (EFS) was assumed for complete responders across both treatments due to differing definitions. Costs were calculated based on published data, including medication and administration expenses, adverse event management, stem-cell transplants, salvage therapies, and terminal care. Utility values were derived from EORTC-8D values in the TOWER trial. A 50-year horizon, a US payer perspective, and a 3% discount rate for costs and QALYs were applied.

The Verdict: Is Blinatumomab a Cost-Effective Option?

The results of all three analyses indicated that blinatumomab was more effective (incremental QALYs ranging from 0.59 to 1.89) and slightly more costly (incremental costs between $27,021 and $29,021). This resulted in ICERs of $14,341, $49,131, and $24,952 per QALY gained, respectively.

These findings suggest that, across various approaches of applying the MAIC results, blinatumomab can be considered a cost-effective treatment option for adults with R/R ALL who have undergone zero or one prior salvage therapy, from a US payer perspective.

Ultimately, the decision to use blinatumomab should be made in consultation with healthcare professionals, considering individual patient factors and the specific clinical context. However, this analysis provides valuable insights into the economic implications of choosing blinatumomab over inotuzumab for R/R ALL treatment.

About this Article -

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Everything You Need To Know

What are blinatumomab and inotuzumab ozogamicin, and how do they differ in treating relapsed or refractory acute lymphoblastic leukemia (R/R ALL)?

Blinatumomab and inotuzumab ozogamicin are two treatment options for adults with relapsed or refractory acute lymphoblastic leukemia (R/R ALL). The primary difference lies in their mechanisms of action and how they target leukemia cells. A key consideration for healthcare providers is determining which treatment offers the best value, balancing effectiveness and cost.

How was the cost-effectiveness of blinatumomab compared to inotuzumab determined in the study for adults with R/R ALL?

The study compared blinatumomab and inotuzumab by estimating the incremental cost-effectiveness ratio (ICER), which represents the cost per quality-adjusted life year (QALY) gained. This involved a matching-adjusted indirect treatment comparison (MAIC) of the TOWER and INO-VATE-ALL trials, using a partitioned-survival model to analyze data and ensure comparable patient characteristics. The goal was to determine if blinatumomab is a worthwhile investment from a US payer perspective.

What specific costs and factors were included in the cost-effectiveness analysis of blinatumomab versus inotuzumab?

The cost-effectiveness analysis considered several factors, including the costs of medication, administration, adverse event management, stem-cell transplants, salvage therapies, and terminal care. Utility values, derived from EORTC-8D values in the TOWER trial, were also factored in. The analysis used a 50-year horizon, a US payer perspective, and a 3% discount rate for both costs and QALYs. Furthermore, event-free survival (EFS) was assumed to be the same for complete responders across both treatments, accounting for differing definitions in the trials.

What were the main findings regarding the cost-effectiveness of blinatumomab compared to inotuzumab, and what do the ICER values suggest?

The results indicated that blinatumomab was slightly more costly but also more effective, leading to ICERs of $14,341, $49,131, and $24,952 per QALY gained across three different analyses. This suggests that, at these ICER values, blinatumomab could be considered a cost-effective option for treating relapsed or refractory acute lymphoblastic leukemia, offering additional quality-adjusted life years at a reasonable cost. However, the acceptability of these ICER values often depends on specific payer thresholds and willingness-to-pay considerations.

Can you describe the different analyses performed to compare the cost-effectiveness of blinatumomab and inotuzumab in treating R/R ALL?

The study conducted three separate analyses to compare blinatumomab and inotuzumab, each with a slightly different approach. The first compared inotuzumab overall survival (OS) using a MAIC-adjusted hazard ratio to blinatumomab MAIC-adjusted TOWER OS. The second assessed inotuzumab and standard-of-care (SOC) OS against blinatumomab OS, applying a MAIC-adjusted hazard ratio. The third performed an unanchored comparison of MAIC-adjusted blinatumomab OS from TOWER and inotuzumab OS from INO-VATE-ALL. These analyses aimed to provide a comprehensive understanding of the cost-effectiveness of blinatumomab under various scenarios.