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

被引:9
作者
Hu, Xingdi [1 ]
Wildman, Kingsley P. [2 ]
Basu, Subham [3 ]
Lin, Peggy L. [1 ]
Rowntree, Clare [4 ]
Saha, Vaskar [5 ,6 ]
机构
[1] Shire, GHEOR Analyt, Cambridge, MA USA
[2] Servier Labs Ltd, Med Affairs Oncol UK & Ireland, Stoke Poges, Bucks, England
[3] Shire Pharmaceut Ltd, Med Affairs Oncol UK & Republ Ireland, London, England
[4] Univ Hosp Wales, Haematol, Cardiff, Wales
[5] Univ Manchester, Div Canc Sci, Sch Med Sci, Fac Biol Med & Hlth, Oglesby Canc Res Bldg,555 Wilmslow Rd, Manchester M20 4GJ, Lancs, England
[6] Tata Med Ctr, Tata Translat Canc Res Ctr, Kolkata, India
关键词
Acute lymphoblastic leukaemia; Asparaginase; Cost-effectiveness; First line treatment; ESCHERICHIA-COLI ASPARAGINASE; STANDARD-RISK; E.-COLI; PEGYLATED-ASPARAGINASE; ERWINIA ASPARAGINASE; REMISSION INDUCTION; REPORTING STANDARDS; ECONOMIC-EVALUATION; PEG-ASPARAGINASE; UKALL; 2003;
D O I
10.1186/s13561-019-0257-3
中图分类号
F [经济];
学科分类号
02 ;
摘要
Background L-asparaginase is a key component of treatment for patients with acute lymphoblastic leukaemia (ALL) in the UK. Commonly used forms of asparaginase are native E. coli-derived asparaginase (native asparaginase) and pegaspargase in first-line combination therapy, and native Erwinia chrysanthemi-derived asparaginase (Erwinia asparaginase) as second-line treatment. The objective of this study was to evaluate the cost-effectiveness of pegaspargase versus native asparaginase in first-line combination therapy for patients with newly diagnosed ALL. A combined decision tree and health-state transition Markov cost-effectiveness model was developed to assess the relative costs and health outcomes of pegaspargase versus native asparaginase in the UK setting. Results In base case analyses, first-line pegaspargase (followed by Erwinia asparaginase in cases of hypersensitivity) dominated first-line native asparaginase followed by Erwinia asparaginase; i.e. resulted in lower costs and more quality-adjusted life year gain. The favourable hypersensitivity rates and administration profile of pegaspargase led to lifetime cost savings of 4741 pound versus native asparaginase. Pegaspargase remained cost-effective versus all treatment strategies in all scenario analyses, including use of the 2500 IU/m(2) dose, recommended for patients <= 21 years of age. Conclusions Pegaspargase, as part of multi-drug chemotherapy, is a cost-effective option for the treatment of newly diagnosed ALL. Based on this study, The National Institute for Health and Care Excellence Technology Appraisal Committee concluded that it could recommend pegaspargase as a cost-effective use of National Health Service resources in England & Wales for treating ALL in children, young people and adults with untreated, newly diagnosed disease.
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页数:13
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