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Bankar A, Korula A, Kulkarni UP, Devasia AJ, Na F, Lionel S, Abraham A, Balasubramanian P, Janet NB, Nair SC, S S, Jeyaseelan V, N J, Prasad J, George B, Mathews V. Resource utilization and cost effectiveness of treating acute promyelocytic leukaemia using generic arsenic trioxide. Br J Haematol 2019; 189:269-278. [PMID: 31863602 DOI: 10.1111/bjh.16343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 09/17/2019] [Indexed: 11/28/2022]
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 three-state 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 ± 2078) was significantly less than for APL-CT (n = 30, $22 600 ± 5528) (P < 0·001). APL-ATO reduced hospitalization, antibiotic and antifungal usage (P < 0·001). In the Markov model, five-year treatment costs were significantly lower for APL-ATO ($11 131) than for APL-CT ($17 926) (P < 0·001). Treatment cost and health resource utilization were significantly lower for generic ATO-treated APL patients compared to the chemotherapy-based regimen.
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Affiliation(s)
- Aniket Bankar
- Department of Hematology, Christian Medical College, Vellore, India
| | - Anu Korula
- Department of Hematology, Christian Medical College, Vellore, India
| | - Uday P Kulkarni
- Department of Hematology, Christian Medical College, Vellore, India
| | - Anup J Devasia
- Department of Hematology, Christian Medical College, Vellore, India
| | - Fouzia Na
- Department of Hematology, Christian Medical College, Vellore, India
| | - Sharon Lionel
- Department of Hematology, Christian Medical College, Vellore, India
| | - Aby Abraham
- Department of Hematology, Christian Medical College, Vellore, India
| | | | | | - Sukesh C Nair
- Department of Immunohematology and Transfusion Medicine, Christian Medical College, Vellore, India
| | - Sezlian S
- Accounts Department, Christian Medical College, Vellore, India
| | - Visali Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Jeyaseelan N
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Jasmine Prasad
- Department of Community Medicine, Christian Medical College, Vellore, India
| | - Biju George
- Department of Hematology, Christian Medical College, Vellore, India
| | - Vikram Mathews
- Department of Hematology, Christian Medical College, Vellore, India
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