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

Abstract

Objectives: Erwinia asparaginase is used as a second-line formulation after a neutralizing hypersensitivity reaction to the first-line formulation of asparaginase. Here, we have performed a costeffectiveness analysis of Erwinia asparaginase treatment. Methods: Children with acute lymphoblastic leukemia treated according to the Dutch ChildhoodOncology ALL-10 or ALL-11 protocol were included and initially treated with PEGasparaginase in the intensification phase. The total treatment costs of this treatment phase, quality of life (QoL), and life years saved (LYS) were studied for two scenarios: (a) patients were switched to Erwinia asparaginase treatment after a hypersensitivity reaction, or (b) asparaginase would have been permanently stopped. Results: Sixty-eight patients were included. There was no difference in QoL between patients with and without a hypersensitivity reaction. The mean costs of the intensification phase per patient were $40,925 if PEGasparaginase could be continued, $175,632 if patients had to switch to Erwinia asparaginase, and $21,190 if asparaginase would have been permanently stopped. An extrapolation of the literature suggests that the 5-year event-free survival would be 10.3% lower without intensive asparaginase treatment if asparaginase is stopped after a reaction. Thus, the costs per LYS were $1892 for scenario 1 and $872 for scenario 2.Conclusions: Switching to Erwinia asparaginase increases the costs per LYS by $1020, which is modest in view of the total costs. Moreover, when asparaginase treatment can be completed by switching to Erwinia asparaginase, relapses-and consequential costs-will be avoided. Therefore, from a cost perspective, we recommend a switch to Erwinia asparaginase to complete asparaginase treatment. K E Y W O R D Sasparaginase, cost-effectiveness analysis, pediatric ALL

Extended enzymatic stability of reconstituted lyophilized PEG-asparaginase in vials

“…The pharmacoeconomic studies that indicate greater efficiency of the use of the non-pegylated form against Oncaspar V R , should now consider our results and include them in their analysis of the cost-effectiveness ratios of both forms of ASNase. 15,16 In conclusion, the activity of PEG-ASNase (Oncaspar V R ) remains stable for at least 14 days after reconstitution at temperatures of 4 C, À20 C and À80 C, which allows to reuse the leftover in posterior administration to the patient and consequently to save up to 50% in the treatment cost.…”

The cost-effectiveness of pegaspargase versus native asparaginase for first-line treatment of acute lymphoblastic leukaemia: a UK-based cost-utility analysis

“…Therefore, accounting for these additional factors from a societal perspective would further favour the current versus the old treatment strategy, suggesting that our findings may be conservative. A recent study in The Netherlands on the cost-effectiveness of switching to Erwinia asparaginase versus discontinuing asparaginase following a hypersensitivity reaction to pegaspargase evaluated cost per life years saved using a wider perspective, including hospital costs, burden of switching and patient experience of the hypersensitivity reactions [51]. They found that although the cost was increased by switching to Erwinia asparaginase, the long-term clinical benefit and reduction in relapse resulting from this intervention versus discontinuing asparaginase completely merited their recommendation of the switch.…”

SOHO State of the Art Updates and Next Questions: Management of Asparaginase Toxicity in Adolescents and Young Adults with Acute Lymphoblastic Leukemia

“…When Asp activity assays are not available, switching should always be considered at any grade of hypersensitivity, most commonly to Erwinase 29 , since even patients with CTCAE grade 1 allergy reactions have neutralizing antibodies causing undetectable activity levels 22 .…”