Based on this model, even with a price equal to ibrutinib, acalabrutinib is not cost effective with a willingness-to-pay threshold of £50,000. The probability of acalabrutinib being cost effective declines with greater efficacy.

Cost-effectiveness analyses for acalabrutinib lead to incentives to show a lack of progression-free survival benefit because the additional costs associated with prolonged progression-free survival are not offset by the additional quality-adjusted life-years gained.

The conflicting effects of quality of life and survival benefits disrupt proper assessment of the added value of acalabrutinib, which might lead to delays in patient access.

To get novel haematological agents to patients effectively and in a timely manner, development should include an early assessment of added value such as that presented here.