Resource utilization and cost effectiveness of treating acute promyelocytic leukaemia using generic arsenic trioxide

Abstract

Arsenic trioxide (ATO)-based regimens are the standard of care for treating acute promyelocytic leukaemia (APL) and have replaced chemotherapy-based approaches. However, the cost of "patented" ATO is prohibitive because of patent rights. "Generic" ATO has been used in a few countries, but its implications for health resource utilization (HRU) and cost of treatment are unknown. We hypothesized that treating APL patients using generic ATO (APL-ATO) will be cost effective compared to the chemotherapy-based regimen (APL-CT). In a single-centre retrospective study, we used a bottom-up costing method to compare the direct medical cost of treatment and HRU between APL-ATO and APL-CT. These costs and the survival and relapse probabilities were imputed in a threestate Markov decision model to estimate the cost effectiveness of APL-ATO compared to APL-CT. The mean cost of treatment for APL-ATO (n = 30, $8500 AE 2078) was significantly less than for APL-CT (n = 30, $22 600 AE 5528) (P < 0Á001). APL-ATO reduced hospitalization, antibiotic and antifungal usage (P < 0Á001). In the Markov model, five-year treatment costs were significantly lower for APL-ATO ($11 131) than for APL-CT ($17 926) (P < 0Á001). Treatment cost and health resource utilization were significantly lower for generic ATO-treated APL patients compared to the chemotherapy-based regimen.

Real world data with concurrent retinoic acid and arsenic trioxide for the treatment of acute promyelocytic leukemia

“…This study illustrates the efficacy of the combination of ATRA and ATO even outside a clinical trial setting and especially its efficacy in combination with anthracycline in the high-risk subset. While a formal cost analysis, similar to what was reported earlier with single-agent generic ATO [ 15 ], was not done, our preliminary analysis does not suggest that this combination approach adds significantly to the cost. The total direct hospital costs incurred for the treatment within 1 year of diagnosis was approximately USD 6400 per patient.…”

“…The limitations of the available real-world data of APL treated with this ATO + ATRA combination are that it is limited by small numbers, intensive use of additional anthracyclines, or being restricted to low and intermediate-risk patients [ 10 – 12 ]. At our tertiary center, we have previously reported on our experience with ATO in APL [ 13 , 14 ] and the cost-effectiveness of this strategy using generic ATO [ 15 ]. Following the publication of the RCTs establishing the efficacy of the combination ATO and ATRA, we changed the standard of care regimens in our institution in January 2015 (summarized in Fig.…”

Resurrection of Oral Arsenic Trioxide for Treating Acute Promyelocytic Leukaemia: A Historical Account From Bedside to Bench to Bedside

“…Treatment with Trisenox ® was inconvenient, cumbersome and prohibitively expensive. Depending on the source, current monthly costs of i.v.-As 2 O 3 -based regimens typically used during induction or re-induction of APL may amount to ~10,000–11,000 U.S. dollars, though more affordable generic formulations are increasingly available ( 8 , 9 ). Moreover, besides the burdensome quality of life impairments and medication costs of such recurrent i.v.…”

Evolving Chemotherapy Free Regimens for Acute Promyelocytic Leukemia

“…Elimination of cytotoxic chemotherapy has potential advantages of reduction in myelosuppression and resulting infections and bleeding, reduction in early risk of hemorrhagic events partly attributed to release of procoagulants after destruction of APL cells, and reduction in risk of long-term complications like cardiotoxicity and secondary myeloid neoplasms (17). Additionally, the health resource utilization and treatment costs are also significantly lower with non-chemotherapy approaches in APL (20). This is of particular significance for low-middle income countries wherein the resources are limited and there is an increasing burden of antimicrobial drug resistance.…”