Journal of medical economics · 2026
Economic burden associated with switching from frontline pegaspargase or calaspargase pegol to second-line recombinant Erwinia in pediatrics and adolescents/young adults with acute lymphoblastic leukemia.
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McCormick Meghan, Gu Tina, Bhagnani Tarun, Prashar Arun, Chatterjee Indrani, Papademetriou Eros, Maese Luke
Аннотация
AIMS: This study aims to quantify costs and healthcare resource utilization (HCRU) associated with switching from frontline (1 L) pegaspargase (PEG)/calaspargase pegol (CAL-PEG) to second-line (2 L) recombinant Erwinia in pediatric and adolescent/young adult (AYA) patients aged <40 years with acute lymphoblastic leukemia (ALL), overall and by use of therapeutic drug monitoring (TDM).
MATERIALS AND METHODS: This was a retrospective study using Optum's deidentified Clinformatics Data Mart database. Pediatric/AYA patients (US) diagnosed with ALL between January 2021 and September 2023 and treated with 1 L asparaginase-containing regimens were identified. Asparaginase switch rates were assessed. HCRU and per-patient per-year (PPPY) costs were compared between patients who completed treatment with PEG/CAL-PEG and those who switched to recombinant Erwinia. Outcomes were compared between patients who received TDM and those who did not.
RESULTS: A total of 154 pediatric/AYA patients with ALL were identified who initiated 1 L treatment with a PEG/CAL-PEG-containing regimen. Overall, 35/154 (22.7%) patients switched from 1 L asparaginase to recombinant Erwinia. Patients who switched from 1 L asparaginase to recombinant Erwinia had significantly higher mean total healthcare costs ($1,006,262 vs. $429,502; p < 0.0001), primarily driven by higher outpatient visits (82.57 vs. 72.75 PPPY; p = 0.0988) and their associated costs ($754,063 vs. $245,978; p < 0.0001), compared with patients who remained on 1 L asparaginase. When compared by use of TDM (61/154 [39.6%]), 28.0% in the non-TDM group and 14.8% in the TDM group switched from 1 L asparaginase to recombinant Erwinia. Mean outpatient costs were $381,017 and $319,468 (p < 0.0003), respectively.
LIMITATIONS: Caution is required in the interpretation of the results of this retrospective study as claims data are not designed specifically for research purposes.
CONCLUSIONS: Switching from 1 L PEG/CAL-PEG to 2 L recombinant Erwinia is associated with higher healthcare costs. Consideration should be given to TDM, which may mitigate unnecessary switches of asparaginase.
MATERIALS AND METHODS: This was a retrospective study using Optum's deidentified Clinformatics Data Mart database. Pediatric/AYA patients (US) diagnosed with ALL between January 2021 and September 2023 and treated with 1 L asparaginase-containing regimens were identified. Asparaginase switch rates were assessed. HCRU and per-patient per-year (PPPY) costs were compared between patients who completed treatment with PEG/CAL-PEG and those who switched to recombinant Erwinia. Outcomes were compared between patients who received TDM and those who did not.
RESULTS: A total of 154 pediatric/AYA patients with ALL were identified who initiated 1 L treatment with a PEG/CAL-PEG-containing regimen. Overall, 35/154 (22.7%) patients switched from 1 L asparaginase to recombinant Erwinia. Patients who switched from 1 L asparaginase to recombinant Erwinia had significantly higher mean total healthcare costs ($1,006,262 vs. $429,502; p < 0.0001), primarily driven by higher outpatient visits (82.57 vs. 72.75 PPPY; p = 0.0988) and their associated costs ($754,063 vs. $245,978; p < 0.0001), compared with patients who remained on 1 L asparaginase. When compared by use of TDM (61/154 [39.6%]), 28.0% in the non-TDM group and 14.8% in the TDM group switched from 1 L asparaginase to recombinant Erwinia. Mean outpatient costs were $381,017 and $319,468 (p < 0.0003), respectively.
LIMITATIONS: Caution is required in the interpretation of the results of this retrospective study as claims data are not designed specifically for research purposes.
CONCLUSIONS: Switching from 1 L PEG/CAL-PEG to 2 L recombinant Erwinia is associated with higher healthcare costs. Consideration should be given to TDM, which may mitigate unnecessary switches of asparaginase.