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

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    Authors
    Hu, X
    Wildman, KP
    Basu, S
    Lin, PL
    Rowntree, C
    Saha, Vaskar
    Affiliation
    GHEOR Analytics, Shire, Cambridge, MA, USA
    Issue Date
    2019
    
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    Abstract
    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 versus native asparaginase. Pegaspargase remained cost-effective versus all treatment strategies in all scenario analyses, including use of the 2500?IU/m2 dose, recommended for patients ²21?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.
    Citation
    Hu X, Wildman KP, Basu S, Lin PL, Rowntree C, Saha V. The cost-effectiveness of pegaspargase versus native asparaginase for first-line treatment of acute lymphoblastic leukaemia: a UK-based cost-utility analysis. Health Econ Rev. 2019;9(1):40.
    Journal
    Health Economics Review
    URI
    http://hdl.handle.net/10541/622739
    DOI
    10.1186/s13561-019-0257-3
    PubMed ID
    31885053
    Additional Links
    https://dx.doi.org/10.1186/s13561-019-0257-3
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1186/s13561-019-0257-3
    Scopus Count
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    All Paterson Institute for Cancer Research

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