Table 3.

Summary of results and conclusions of the included studies

References	Country	Abbreviation of the compared regimens	Cost per QALY gain in base case scenario + Study conclusion
Studies comparing treatment regimens and calculating cost per QALY gain (n = 26)
Main et al.[29]	UK	FC-R vs FR; FC-R vs Clb	13,189 GBP (FC-R vs FR); 6422 GBP (FC-R vs Clb)	Addition of R to FC is cost effective
Hornberger et al. [27]	USA	FC-R vs FC	23,530 USD
Adena et al. [26]	Australia	FC-R vs FC	42,906 AUD
Mandrik et al. [30]	Ukraine	FC-R vs FC	8704 USD (1st line); 11,056 USD (R/R)
Müller et al. [31]	Germany	FC-R vs FC	17,979 EUR
Williams et al. [46]	UK	FC-R vs FC	16,308 GBP (Partitioned Survival); 13,189 GBP (Markov)
Woods et al. [42]	UK	B vs Clb	11,960 GBP	Bendamustine is cost effective in 1st line
Kongnakorn et al. [22]	USA	B vs A vs Clb	50,619 USD (B vs Clb); dominant (B vs A)
Becker et al. [32]	UK	G-Clb vs R-Clb vs Clb vs B vs R-B vs O-Clb	<30,000 GBP for each comparator	Obinutuzumab + chlorambucil is cost effective in 1st line
Blommestein et al. [33]	Netherlands	G-Clb vs R-Clb vs O-Clb vs Clb	<30,000 EUR for each comparator
Casado et al. [34]	Spain	G-Clb vs R-Clb	24,838 EUR
Soini et al. [37]	Finland	G-Clb vs O-Clb vs R-B vs R-Clb vs Clb	29,334 EUR (G-Clb vs Clb); 43,958 EUR (R-Clb vs Clb); 59,316 EUR (RB vs Clb); 82,159 EUR (O-Clb vs Clb)
Paquete et al. [35]	Portugal	G-Clb vs R-Clb vs Clb	20,397 EUR (G-Clb vs Clb); dominated (G-Clb vs R-Clb)
Barnes et al. [38]	USA	Ibr vs Clb / G-Clb (theoretical alternative)	189,000 USD	Ibrutinib is not cost effective in 1st line, price reduction is needed
Sinha and Redekop [36]	UK	Ibr vs G-Clb	75,648 GBP
Patel et al. [20]	USA	Ibr in the 1st line vs Ibr in the 3rd line	2,350,041 USD
Scott and Scott [23]	New Zealand	A vs FC-R	46,016 NZD (Alemtuzumab); 60,012 (FCR) Alemtuzumab is cost effective in 3rd-line treatment
Howard et al. [28]	UK	FC-R vs FCM-miniR	10,651 EUR (Cost saving with QALY loss) FCM-miniR produces a cost saving and QALY loss in 1st line
Herring et al. [40]	Canada	O-Clb vs Clb	68,647 CAD Ofatumumab + chlorambucil is cost effective in first line
Hatswell et al. [44]	UK	O vs BSC	130,563 GBP Ofatumumab is not cost effective for double-refractory patients
Mistry et al. [45]	UK	Ven vs BSC	39,940 GBP (del(17p)/TP53); 47,370 GBP (non-del(17p)/TP53) Venetoclax is not cost effective for relapsed or refractory patients
Casado et al. [43]	Spain	Ide-R vs R	29,990 EUR Idelalisib + rituximab is cost effective for relapsed or refractory patients
Vreman et al. [41]	UK	Acp vs Ibr	61,941 GBP Acalabrutinib is not cost effective in relapsed patients
Weeks et al. [25]	USA	Ig vs No Ig	6,000,000 USD Immune globulin is not cost effective in patients with high risk for infection
Buchanan et al. [19]	UK	Genetic testing + no Ibr vs Genetic testing + Ibr vs No genetic or genomic testing vs Genomic testing + Ibr vs Genomic testing + Ibr + O	8565 GBP (Scenario 1 vs 3); 31,153 GBP (Scenario 2 vs 3); 50,559 GBP (Scenario 4 vs 3); 177,198 GBP (Scenario 5 vs 3) Use of genomic testing was not cost effective
Chen et al. [21]	USA	CIT regimens will be replaced by oral targeted therapies by 2025 vs CIT would remain the standard of care for the period	189,000 USD More sustainable pricing strategies for targeted therapies are needed

A alemtuzumab, Acp acalabrutinib, AUD Australian dollars, B bendamustine, BSC best supportive care, CAD Canadian dollars, CHOP cyclophosphamide-vincristine-prednisone-doxorubicin, CIT chemo-immunotherapy, Clb chlorambucil, EUR Euros, F fludarabine, FC fludarabine-cyclophosphamide, FCM-miniR fludarabine-cyclophosphamide-mitoxantrone-low-dose rituximab, FC-R fludarabine-cyclophosphamide-rituximab, GBP British pounds, G-Clb obinutuzumab-chlorambucil, Ibr ibrutinib, Ide-R idelalisib-rituximab, Ig immunoglobulin, NZD New Zealand dollars, O-Clb ofatumumab-chlorambucil, R rituximab, R-B rituximab-bendamustine, R-Chemo rituximab + chemotherapy, R-Clb rituximab-chlorambucil, R/R relapsed or refractory, USD United States dollars, Ven venetoclax