Decreasing Cost and Decreasing Length of Stay After Implementation of Updated High-Dose Methotrexate Discharge Criteria

Binder, Adam; Burdette, Samantha; Galanis, Patricia; Birchmeier, Katlin; Handley, Nathan; Piddoubny, Maria

doi:10.1200/jop.19.00566

Cited by 4 publications

(6 citation statements)

References 18 publications

(23 reference statements)

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“…○ Calculated by applying the same proportional increase between the hospitalization cost for no toxicity and the cost for toxicity but no hemodialysis (Candrilli et al, 2008) 23 to an alternative hospitalization cost for no toxicity of $1678.05 per day (Binder et al, 2020) 33 (inflated from $1563.15 per day in 2019).…”

Section: Hypothetical Practical Scenariosmentioning

confidence: 99%

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Glucarpidase for Treating Adults with Delayed Methotrexate Elimination Due to Impaired Renal Function: An Economic Simulation Analysis

Kala¹,

Nelson²,

Drudge³

et al. 2023

CEOR

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Background: Glucarpidase is indicated for treating delayed methotrexate (MTX) elimination due to impaired renal function. Although glucarpidase is capable of rapidly eliminating MTX independent of renal clearance, its cost can be perceived as a barrier to use. However, no published economic analyses have evaluated glucarpidase relative to comparable treatments. Purpose: To assess the economic value of glucarpidase for treating adult patients in the United States (US) who experience delayed MTX elimination due to impaired renal function. Methods: A decision tree model was developed to assess the economic value of glucarpidase. The short-term inpatient management of patients as well as long-term survival were simulated. Costs associated with the use of glucarpidase were compared against other methods for treating delayed MTX elimination due to impaired renal function under two scenarios: current practice (ie, mix of timely/ delayed use of glucarpidase, hemodialysis, or supportive care [SC] alone) as compared with proposed practice (ie, timely glucarpidase administration within 60 hours for all eligible patients). Hypothetical practical scenarios for US institutions were also considered. Results: For adult patients with delayed MTX elimination, proposed practice as compared to current practice was associated with an increased cost of $20,024 per patient, not considering any incremental reimbursement associated with glucarpidase administration. Importantly, early treatment with glucarpidase, within 60 hours, was shown to be less expensive per patient than delayed glucarpidase treatment or treating with hemodialysis, but more expensive than SC alone. However, proposed practice was associated with multiple clinical benefits, including shorter hospital length of stay. For hypothetical practical scenarios, minimal shifts in treatment patterns had minimal cost impacts. Conclusion:Treatment of all eligible patients with glucarpidase within 60 hours was associated with an increased cost per patient (relative to current practice) but substantial improvements in clinical outcomes. Timely glucarpidase use was less expensive than delayed glucarpidase or hemodialysis.

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Section: Hypothetical Practical Scenariosmentioning

confidence: 99%

“…○ Calculated by applying the same proportional increase between the hospitalization cost for no toxicity and the cost for toxicity and hemodialysis (Candrilli et al, 2008) 23 to the above $1678.05 per day value (Binder et al, 2020). 33 Decreased ICU costs…”

Section: Hypothetical Practical Scenariosmentioning

confidence: 99%

Glucarpidase for Treating Adults with Delayed Methotrexate Elimination Due to Impaired Renal Function: An Economic Simulation Analysis

Kala¹,

Nelson²,

Drudge³

et al. 2023

CEOR

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“…Furthermore, there is a lack of pharmacogenomic data on HDMTX metabolism among LMIC patients. Though decreasing the duration of prehydration, oral alkalinization, discharge at higher MTX levels, and standard checklists may reduce the toxicity and supportive care costs, studies from India have established higher treatment costs for HDMTX‐based protocols 6,43–47 . The additional challenge in osteosarcoma is the longer treatment duration of the HDMTX protocols than the non‐HDMTX protocols, leading to significant social and logistic issues in the AYA population 46,48 …”

Section: Systemic Therapy Evolution In Osteosarcoma ‐ Lmic Perspectivementioning

confidence: 99%

“…Centers reported 5‐year relapse/progression‐free (PFS) survival rates in patients with osteosarcoma ranging from 40% to 68% with various combinations of the other active drugs (Figure 3A,B; Table 3). 7,8,42–61 The initial proof of non‐HDMTX protocols came from the European Osteosarcoma Intergroup (EOI) trials. While the first EOI trial compared two‐drug protocol Adriamycin‐ cisplatin (AP) to AP with HDMTX, the second trial compared AP to a T10‐like multidrug protocol 48,62 .…”

Section: Systemic Therapy Evolution In Osteosarcoma ‐ Lmic Perspectivementioning

confidence: 99%

Resource‐appropriate selection of osteosarcoma treatment protocols in low‐ and middle‐income countries

Mailankody

Kumar

Khan

et al. 2021

Pediatric Blood & Cancer

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Osteosarcoma is a rare malignancy; however, it is still the most common primary bone tumor in adolescents and young adults. Chemotherapy improves survival indubitably in osteosarcoma; nevertheless, the concern is the stagnant progress since the last several decades. There are a handful of active agents and unresolved issues, especially in choosing the ideal chemotherapy regimen. The oncology community is in equipoise regarding the position of high‐dose methotrexate (HDMTX), mandatory or adjunct. The choice of therapy becomes widely relevant, including in low‐ and middle‐income countries (LMIC), where HDMTX administration brings additional complexities. Research into novel non‐HDMTX‐based protocols adapted to the available resources is pivotal in improving disease outcomes, especially in LMIC. The current review focuses on real‐world challenges in decision‐making and provides a comprehensive overview of the evolution of treatment protocols in LMIC.

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“…[7] Notably, OS patients also have a significant economic burden when faced with other complications. [8] Therefore, exploring an efficient and safe strategy to treat OS is still an important topic and hotspot in the field of current medicine.…”

Section: Introductionmentioning

confidence: 99%

Effect of traditional Chinese medicine in osteosarcoma: Cross-interference of signaling pathways and potential therapeutic targets

Liu,

Jiang,

et al. 2024

Medicine

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Osteosarcoma (OS) has a high recurrence rate, disability rate, mortality and metastasis, it brings great economic burden and psychological pressure to patients, and then seriously affects the quality of life of patients. At present, the treatment methods of OS mainly include radiotherapy, chemotherapy, surgical therapy and neoadjuvant chemotherapy combined with limb salvage surgery. These treatment methods can relieve the clinical symptoms of patients to a certain extent, and also effectively reduce the disability rate, mortality and recurrence rate of OS patients. However, because metastasis of tumor cells leads to new complications, and OS cells become resistant with prolonged drug intervention, which reduces the sensitivity of OS cells to drugs, these treatments still have some limitations. More and more studies have shown that traditional Chinese medicine (TCM) has the characteristics of “multiple targets and multiple pathways,” and can play an important role in the development of OS through several key signaling pathways, including PI3K/AKT, Wnt/β-catenin, tyrosine kinase/transcription factor 3 (JAK/STAT3), Notch, transforming growth factor-β (TGF-β)/Smad, nuclear transcription factor-κB (NF-κB), mitogen-activated protein kinase (MAPK), nuclear factor E2-related factor 2 (Nrf2), Hippo/YAP, OPG/RANK/RANKL, Hedgehog and so on. In this paper, the signaling pathways of cross-interference between active ingredients of TCM and OS were reviewed, and the development status of novel OS treatment was analyzed. The active ingredients in TCM can provide therapeutic benefits to patients by targeting the activity of signaling pathways. In addition, potential strategies for targeted therapy of OS by using ferroptosis were discussed. We hope to provide a unique insight for the in-depth research and clinical application of TCM in the fields of OS growth, metastasis and chemotherapy resistance by understanding the signaling crosstalk between active ingredients in TCM and OS.

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Decreasing Cost and Decreasing Length of Stay After Implementation of Updated High-Dose Methotrexate Discharge Criteria

Cited by 4 publications

References 18 publications

Glucarpidase for Treating Adults with Delayed Methotrexate Elimination Due to Impaired Renal Function: An Economic Simulation Analysis

Glucarpidase for Treating Adults with Delayed Methotrexate Elimination Due to Impaired Renal Function: An Economic Simulation Analysis

Resource‐appropriate selection of osteosarcoma treatment protocols in low‐ and middle‐income countries

Effect of traditional Chinese medicine in osteosarcoma: Cross-interference of signaling pathways and potential therapeutic targets

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