What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool

Abstract

ObjectiveInsufficient access to anticancer medicines may contribute to the wide survival differences of children with cancers across the globe. We developed a tool to estimate the volume of medicines and budget requirements to provide chemotherapy to children with acute lymphoblastic leukaemia (ALL).DesignDevelopment and application of an estimation tool.SettingPaediatric oncology hospital departments in Thailand.Participants318 children aged 0–14 years diagnosed with ALL and 215 children with undiagnosed ALL.InterventionsEstimates of volume and budget requirements for administering a full course of chemotherapy for ALL and a further course for children who relapse, according to National Treatment Guidelines.Primary and secondary outcome measuresPrimary outcome measures were the volume (mg) and cost (US$) of medicines needed to treat children with ALL. For medicines whose main indication is paediatric ALL (asparaginase and 6-mercaptopurine), we estimated the difference between volume needed and actual sales in 2017 (secondary outcome).ResultsTen anticancer medicines and four chemoprotective agents are needed for the treatment of paediatric ALL according to the Thai treatment guidelines. Of these 14 medicines, 13 are included in the WHO essential medicines list for children. All are available as generics. We estimated that essential chemotherapy and chemoprotective agents to treat all children diagnosed with ALL in Thailand in 2017 would cost US$ 814 952 (US$ 1 365 422 for diagnosed and undiagnosed children), which corresponds to 0.005% (0.008%) of the country’s total health expenditure. The volumes of asparaginase and 6-mercaptopurine available on the Thai market in 2017 were more than sufficient (2.3 and 1.5 times the amounts needed, respectively) to treat all children diagnosed with ALL.ConclusionsProcuring sufficient quantities of essential medicines to treat children with ALL requires relatively modest resources. Medicine cost should not be a major barrier to ALL treatment in similar settings.

Cost-Effectiveness of the treatment protocols of pediatrics with ‎Acute ‎Lymphoblastic Leukemia (Decision tree modeling)

“…The QALY of this study is similar to other protocols but its varied in costs relatively [17,18]. Similar studies among other worlds countries showed that in European countries and USA the cost is much higher than the cost of similar protocols in other Asian and American countries [19], but based on the demographic characteristics in table 4-3 the average age of the children is about 9 years and the incidence and prevalence of the disease in hoys is always more than of girls which is similar in other studies [10]. the average length of hospitalization is an important factor influencing the cost of treatment as this study indicates a significant difference in the cost difference between the two protocols.…”

Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

“…Five studies were exclusive to long‐term cancer survivors, two of which were 3‐ and 5‐year post cancer diagnosis 25,26,28,30,54 . In the rest of the studies, participants either were still with cancer, 27,29,32,34,35,42,44–47,55 within 1‐year post diagnosis 37,49,50 or up to 3‐year post diagnosis 31,33,53 …”

“…More than half of the studies (n = 16, 53%) reported costs for both children and adolescents 0-19 years. Other studies were exclusive to children 0 to 14 years (n = 4, 13%), 39,[47][48][49] AYA aged 15 to 39 years (n = 5, 17%), 25,26,30,33,36 or adolescents 15 to 19 years (n = 1, 3%). 40 Four studies (n = 4, 13%) covered the whole spectrum of children and AYA aged 0-39 years 27,28,31,46 (Table 1, Table S1).…”

“…Most studies were observational by design. These included retrospective cohorts (n = 19, 63%), panel surveys (n = 3, 10%), cross-sectional analysis (n = 3, 10%), two costeffectiveness analyses, 44,46 one external validation study 42 and two cost analyses 45,47 (Table 1, Table S1).…”

“…36,43 Five studies were exclusive to long-term cancer survivors, two of which were 3-and 5-year post cancer diagnosis. 25,26,28,30,54 In the rest of the studies, participants either were still with cancer, 27,29,32,34,35,42,[44][45][46][47]55 within 1-year post diagnosis 37,49,50 or up to 3-year post diagnosis. 31,33,53 Cost estimates were limited in time or specific to a particular care phase, cancer type, type of cost (e.g., hospital use and medication costs).…”