Pan-European multicentre economic evaluation of recombinant urate oxidase (rasburicase) in prevention and treatment of hyperuricaemia and tumour lysis syndrome in haematological cancer patients.
OBJECTIVE
Hyperuricaemia (HU) and tumour lysis syndrome (TLS) are complications of acute myeloid/lymphoid leukaemia (AML/ALL) and non-Hodgkin lymphoma (NHL) leading to increased morbidity and mortality. The objective was to assess incremental cost-effectiveness ratios (ICER) of preventing/treating HU and TLS with recombinant urate oxidase, rasburicase (Fasturtec/Elitek).


METHODS
Incidence and costs of HU and TLS were based on a multi-country chart review. Life expectancy at the time of diagnosis was based on published survival rates and age at diagnosis. Reductions of HU/TLS following treatment with rasburicase were based on clinical trial data.


RESULTS
Prevention with rasburicase appears highly cost-effective in children (ICER between Eur 425 and Eur 3054 per life-year saved, LYS). In adults, prevention is more cost-effective in NHL and ALL (maximum ICER of Eur 41383 and Eur 32126 per LYS). Treatment of established HU/TLS with rasburicase is cost-saving in children and highly cost-effective in adults. The results are robust in children. In adults, the prevention strategy appears sensitive to the risk of HU/TLS.


CONCLUSIONS
In conclusion, rasburicase, in addition to the demonstrated clinical benefit, is an economically attractive new option in the treatment of HU, both in adults and children. In prevention the drug has an attractive economic profile in children, and is cost-effective in adults with ALL and NHL.
Annemans
L
L
HEDM (Health Economics and Disease Management), Brusselsesteenweg 91, 1860, Meise, Belgium. lieven.annemans@hedm.be
Moeremans
K
K
Lamotte
M
M
Garcia Conde
J
J
van den Berg
H
H
Myint
H
H
Pieters
R
R
Uyttebroeck
A
A
D000328:Adult; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015994:Incidence; D007938:Leukemia / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D014503:Urate Oxidase / Q000191:economics* / Q000627:therapeutic use*
C469709:rasburicase; D014503:Urate Oxidase