A cost analysis of individualized asparaginase treatment in pediatric acute lymphoblastic leukemia
Background: Therapeutic drug monitoring (TDM) of asparaginase is necessary to respond to variability in asparaginase activity levels, detect silent inactivation, and distinguish between real allergies and allergic-like reactions with and without asparaginase neutralization, respectively. In this study, the costs of an individualized and fixed asparaginase dosing schedule were compared. Procedure: Patients, treated according to the Dutch Childhood Oncology Group ALL-11 protocol (individualized PEGasparaginase treatment, starting dose: 1,500 IU/m2) or ALL-10 protocol (native Escherichia coli asparaginase followed by 2,500 IU/m2 PEGasparaginase), were included. To focus on TDM of PEGasparaginase, the costs were also calculated excluding patients treated with Erwinia asparaginase and compared to a hypothetical protocol with a fixed dose of 1,500 IU/m2 PEGasparaginase. Direct asparaginase-related medical costs, including costs for asparaginase use (calculated with the absolute dose), TDM, laboratory tests, daycare treatment, and outpatient clinic visits, were calculated. Results: Eighty-three ALL-10 patients and 51 ALL-11 patients were included. The asparaginase-related costs were 30.8% lower in ALL-11 than in ALL-10 ($29,048 vs. $41,960). The ALL-11 costs of nonallergic patients were 20.4% lower, when using TDM, than the hypothetical protocol with a fixed dose of 1,500 IU/m2 ($13,178 vs. $16,551). TDM accounted for 12.4% of the costs. Including asparaginase waste, TDM in ALL-11 will be cost saving if three doses can be prepared out of one vial compared to a fixed dose of 1,500 IU/m2. Conclusions: TDM of asparaginase is cost saving if calculated with the absolute asparaginase dose and will be if the waste is minimalized by preparing multiple doses out of one vial.
|Keywords||Acute lymphoblastic leukemia, Asparaginase, Cost analysis, Therapeutic drug monitoring|
|Persistent URL||dx.doi.org/10.1002/pbc.26651, hdl.handle.net/1765/100997|
|Journal||Pediatric Blood & Cancer|
Kloos, R.Q.H, Uyl-de Groot, C.A, van Litsenburg, R.R, Kaspers, G.J, Pieters, R, & van der Sluis, I.M. (2017). A cost analysis of individualized asparaginase treatment in pediatric acute lymphoblastic leukemia. Pediatric Blood & Cancer. doi:10.1002/pbc.26651