Top

Supportive Care in Cancer

Published in:

01-04-2003 | Original Article

Pan-European multicentre economic evaluation of recombinant urate oxidase (rasburicase) in prevention and treatment of hyperuricaemia and tumour lysis syndrome in haematological cancer patients

Authors: L. Annemans, K. Moeremans, M. Lamotte, J. Garcia Conde, H. van den Berg, H. Myint, R. Pieters, A. Uyttebroeck

Published in: Supportive Care in Cancer | Issue 4/2003

Abstract

Goals

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).

Patients and 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 €425 and €3054 per life-year saved, LYS). In adults, prevention is more cost-effective in NHL and ALL (maximum ICER of €41,383 and €32,126 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, Moeremans K (2001) Cost of managing severe hyperuricemia and tumour lysis syndrome in haematologic malignancies (abstract). Value Health 4(6):PCN8

Berrino F, Capocaccia R, Estève J, Gatta G, Hakulinen T, Micheli A, et al (1999) Survival of cancer patients in Europe: the EUROCARE-2 study (scientific publication no. 151). International Agency for Research on Cancer, Lyon

Coebergh JW, Pastore G, Gatta G, Corazziori I, Kamps W, and The Eurocare Working Group (2001) Variation in survival of European children with acute lymphoblastic leukaemia diagnosed in 1978–1992: the EUROCARE study. Eur J Cancer 37:687–694CrossRefPubMed

Coleman MP, Babb P, Damiecki P, Grosclaude P, Honjo S, Jones J, et al (2001) Cancer survival trends in England and Wales, 1971–1995: deprivation and NHS region (Studies in Medical and Population Subjects no. 61). Office for National Statistics, London

Diabetes Control and Complications Trial Research Group (1996) Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. JAMA 276:1409–1415PubMed

Gatta G, Luksch R, Coleman M.P, Corazziari I, and The Eurocare Working Group (2001) Survival from acute non-lymphocytic leukaemia (ANLL) and chronic myeloid leukaemia (CML) in European children since 1978: a population-based study. Eur J Cancer 37:695–702CrossRefPubMed

Gold MR, Siegel JE, Russel LB, Weinstein MC (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York Oxford

Goldman SC, Holcenberg JS, Finklestein JZ, Hutchinson R, Kreissman S, Johnson FL, et al (2001) A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk of tumor lysis. Blood 97:2998–3003CrossRefPubMed

Grimwade D, Walker H, Oliver F, Wheatley K, Harrison C, Harrison G, et al (1998) The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML 10 trial. Blood 92:2322–2333PubMed

10.

Jones DP, Mahmoud H, Chesney RW (1995) Tumor lysis syndrome: pathogenesis and management. Pediatr Nephrol 9:206–212PubMed

11.

Pastore G, Magnani C, Verdecchia A, Pession A, Viscomi S, Coebergh JWW, et al (2001) Survival of childhood lymphomas in Europe, 1978–1992: a report from the EUROCARE study. Eur J Cancer 37:703–710PubMed

12.

Pui CH, Relling MV, Lascombes F, Harrison PL, Struxiano A, Mondesir JM, et al (1997) Urate oxidase in prevention and treatment of hyperuricaemia associated with lymphoid malignancies. Leukemia 11:1813–1816CrossRefPubMed

13.

Pui CH, Jeha S, Irwin D, Camitta B (2001) Recombinant urate oxidase (rasburicase) in the prevention and treatment of malignancy associated hyperuricemia in paediatric and adult patients: results of a compassionate use trial. Leukemia 15:1505–1509CrossRefPubMed

14.

Pui CH, Mahmoud H, Wiley JM, Woods GM, Leverger G, Camitta B, et al (2001) Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma. J Clin Oncol 19:697–704PubMed

15.

Rutten-van Molken MP, van Doorslaer EK, van Vliet RC (1994) Statistical analysis of cost outcomes in a randomized controlled clinical trial. Health Econ 3:333–345PubMed

16.

Seidemann K, Meyer U, Jansen P, Yakisan E, Rieske K, Führer M, et al (1998) Impaired renal function and tumor lysis syndrome in pediatric patients with non-Hodgkin's lymphoma and B-ALL. Observations from the BFM-trials. Klin Pädriatr 210:279–284

17.

Simoons ML (2000) Cholesterol-lowering therapy; a recommendation from the Health Council (in Dutch). Ned Tijdschr Geneeskd 144:2442–2444PubMed

18.

Stolk E, Busschbach J (2000) Cost effectiveness of sildenafil calls for political discussion. BMJ 321:510CrossRef

19.

Tomera JF (1999) Acute tumor lysis syndrome: considerations of cause and prevention. Drugs Today 35:79–87

20.

Van Der Klooster JM, Van Der Wiel HE, Van Saase JLCM, Grootendorst AF (2000) Asystole during combination chemotherapy for non-Hodgkin's lymphoma: the acute tumor lysis syndrome. Neth J Med 56:147–152CrossRefPubMed

21.

Wolf G, Hegewisch-Becker S, Hossfeld DK, Stahl RAK (1999) Hyperuricaemia and renal insufficiency associated with malignant disease: urate oxidase as an efficient therapy? Am J Kidney Dis 34:E20PubMed

Title: Pan-European multicentre economic evaluation of recombinant urate oxidase (rasburicase) in prevention and treatment of hyperuricaemia and tumour lysis syndrome in haematological cancer patients
Authors: L. Annemans
K. Moeremans
M. Lamotte
J. Garcia Conde
H. van den Berg
H. Myint
R. Pieters
A. Uyttebroeck
Publication date: 01-04-2003
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 4/2003
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-002-0435-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Goals

Patients and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2003

Cyclo-oxygenase II inhibitors in the treatment of neoplastic fever

Topical application of honey in the management of radiation mucositis. A Preliminary study

Leucopenia is an independent predictor in cancer patients requiring invasive mechanical ventilation: a prognostic factor analysis in a series of 168 patients

Dangerous nutrition

April 2003

April 2003

Keynote webinar | Spotlight on antibody–drug conjugates in cancer