A cost analysis of individualized asparaginase treatment in pediatric acute lymphoblastic leukemia

Abstract

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.

A cost‐effectiveness analysis of Erwinia asparaginase therapy in children with acute lymphoblastic leukemia

“…All costs were converted to US dollars according to the average currency exchange rate of 2015 (€1 = $1.067). The costs included were costs for (a) PEGasparaginase ($1387 for one vial of 3750 IU) and Erwinia asparaginase ($850 for one vial of 10,000 IU), rounded to whole vials to take into account the waste; (b) chemotherapy other than asparaginase; (c) supportive care medication; (d) outpatient clinic visits ($175 per visit in an academic hospital, $85 in a satellite hospital); (e) day care admissions; (f) inpatient days ($689 per day in an academic hospital, $476 in a satellite hospital); (g) intensive care unit days ($2163 per day); (h) blood products, (i) laboratory tests; (j) surgical procedure costs (mainly for bone marrow punctures performed under complete anesthesia); and (k) TDM costs ($105, including asparaginase activity level measurements and the formulation of dosing advices). The costs described included costs for staff, materials used, nutrition, and overhead.…”

“…In most developed countries, PEGasparaginase is now used as a first‐line formulation and Erwinia asparaginase as a second‐line formulation. The latter formulation is administered more frequently than PEGasparaginase (three times a week instead of every other week) due to different half‐lives of the two drugs, resulting in a substantial increase in therapy costs . Due to increasing restrictions on health care resources, evaluations of costs in relation to benefits become more important, especially for expensive drugs, such as Erwinia asparaginase.…”

A comprehensive review of economic evaluations of therapeutic drug monitoring interventions for cancer treatments

“…The remaining publications analysed TDM interventions for breast cancer [21], head and neck cancer [22], gastrointestinal stromal tumour [23], acute lymphoblastic leukemia [26], and pancreatic cancer [17]. One publication assessed hypothetical pharmacokinetic dosing regimens for two treatments for melanoma [27].…”

“…Half of the full-text economic evaluations adequately described the clinical effectiveness data or describe the methods of identifying clinical effectiveness data [22,27]. Three of six publications did not state the sources of funding [24,26,27].…”

The effect of asparaginase therapy on methotrexate toxicity and efficacy in children with acute lymphoblastic leukemia

“…During the following intensification phase, standard risk patients received one more PEGasparaginase dose; medium risk patients another 14 doses. The medium risk patients who were treated according to the continuous dosing schedule, received the PEGasparaginase once every two weeks, also during the consecutive courses 1(B) and M. The PEGasparaginase doses were individualized after the third dose, based on asparaginase activity levels [23].…”