Cost-Effectiveness of the treatment protocols of pediatrics with Acute Lymphoblastic Leukemia (Decision tree modelling)
Cost-Effectiveness of the treatment protocols
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Abstract
Background: Acute lymphoblastic leukemia (ALL) has a high prevalence at early age and in children and regard to life expectancy index this disease cause to losing many years of life in these patients. Two well-known European protocols called United Kingdom (UK-ALL) and Berlin-Frankfurt-Munster (BFM-ALL) protocols are used to treat the disease in most countries of the world and in Iran, so the objective of this study is modelling of the treatment process using both protocols to estimate more cost-effectiveness method. Methods: A decision tree model was applied to depict the real treatment process to calculate costs per quality-adjusted life-year (QALY). Total costs were included to the model. Results: The cost effectiveness ratio of UK-ALL is lower than BFM-ALL (1145.52 USD /3.87 QALY for UK-ALL and 1942.35 USD /3.02 QALY for BFM-ALL). Therefore, the UK-ALL is dominant and BFM-ALL is dominated. Conclusions: The modeling results showed a double difference between the two studied options so to better cancer management, policymakers and oncologist should advocate the economic evaluation methods and modeling to select a real option in the treatment of patients to save resources like UK-ALL.
Lymphoblastic Leukemia in Children in China’. JCO Global Oncology, vol. 7, no. 7, American Society of Clinical Oncology (ASCO), July 2021, pp. 1176–1186, https://doi.org10.1200/GO.21.00049.
[2] Hayati, Hadi, Abbas Kebriaeezadeh, Mohammad-Ali Ehsani, et al. ‘Cost-Analysis of Treatment of Childhood Acute Lymphoblastic Leukemia Based on UKALL Protocol’. Iranian Journal of Pediatrics, vol. In Press, no. In Press, Briefland, Sept. 2018, https://doi.org10.5812/ijp.7985.
[3] Conter, V., M. Aricò, M. G. Valsecchi, et al. ‘Extended Intrathecal Methotrexate May Replace Cranial Irradiation for Prevention of CNS Relapse in Children with Intermediate-Risk Acute Lymphoblastic Leukemia Treated with Berlin-Frankfurt-Münster-Based Intensive Chemotherapy. The Associazione Italiana Di Ematologia Ed Oncologia Pediatrica’. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, vol. 13, no. 10, American Society of Clinical Oncology (ASCO), Oct. 1995, pp. 2497–2502, https://doi.org10.1200/JCO.1995.13.10.2497.
[4] Hayati, Hadi, Abbas Kebriaeezadeh, Mohammad Ali Ehsani, et al. ‘Cost-Utility of Protocols of BFM-ALL and UK-ALL for Treatment of Children with Acute Lymphoblastic Leukemia in Iran’. Iranian Journal of Public Health, vol. 47, no. 3, Mar. 2018, pp. 407–412, https://www.ncbi.nlm.nih.gov/pubmed/29845029.
[5] Hayati, Hadi. ‘Comparison of the Unit Cost of Diagnostic Imaging Services before and during the COVID-19 Pandemic Using the Activity-Based Costing (ABC) Method’. Iranian Journal of Radiology: A Quarterly Journal Published by the Iranian Radiological Society, vol. 19, no. 3, Briefland, Oct. 2022, https://doi.org10.5812/iranjradiol-123781.
[6] Schrappe, M. ‘A Cost Comparison Analysis of Paediatric Intermediate Care in a Tertiary Hospital and an Intermediate Care Facility in Cape Town’. Plos One, no. 12, South Africa, 2000.
[7] Duncan, Kristal, and Edina Sinanovic. ‘A Cost Comparison Analysis of Paediatric Intermediate Care in a Tertiary Hospital and an Intermediate Care Facility in Cape Town, South Africa’. PloS One, vol. 14, no. 4, Public Library of Science (PLoS), Apr. 2019, p. e0214492, https://doi.org10.1371/journal.pone.0214492.
[8] Doshmangir, Leila, et al. ‘Correction to: Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta‑analysis’. Applied Health Economics and Health Policy, vol. 19, no. 6, Springer Science and Business Media LLC, Nov. 2021, p. 953, https://doi.org10.1007/s40258-021-00686-w.
[9] James, S. L. ‘Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study’. The Lancet, vol. 392, 1990, pp. 1789–1858.
[10] ---. ‘Prevention of CNS Recurrence in Childhood ALL: Results with Reduced Radiotherapy Combined with CNS-Directed Chemotherapy in Four Consecutive ALL-BFM Trials’. Klinische Padiatrie, vol. 210, no. 4, Georg Thieme Verlag KG, July 1998, pp. 192–199, https://doi.org10.1055/s-2008-1043878.
[11] Conter, V., M. Aricò, G. Basso, et al. ‘Long-Term Results of the Italian Association of Pediatric Hematology and Oncology (AIEOP) Studies 82, 87, 88, 91 and 95 for Childhood Acute Lymphoblastic Leukemia’. Leukemia, vol. 24, no. 2, Springer Science and Business Media LLC, Feb. 2010, pp. 255–264, https://doi.org10.1038/leu.2009.250.
[12] Eden, O. B., G. Harrison, et al. ‘Long-Term Follow-up of the United Kingdom Medical Research Council Protocols for Childhood Acute Lymphoblastic Leukaemia, 1980–1997’. Leukemia, vol. 14, no. 12, Springer Science and Business Media LLC, Dec. 2000, pp. 2307–2320, https://doi.org10.1038/sj.leu.2401962.
[13] Mitchell, C., et al. ‘Long-Term Follow-up of the United Kingdom Medical Research Council Protocols for Childhood Acute Lymphoblastic Leukaemia, 1980-2001’. Leukemia, vol. 24, no. 2, Springer Science and Business Media LLC, Feb. 2010, pp. 406–418, https://doi.org10.1038/leu.2009.256.
[14] Eden, O. B., J. S. Lilleyman, et al. ‘Results of Medical Research Council Childhood Leukaemia Trial UKALL VIII (Report to the Medical Research Council on Behalf of the Working Party on Leukaemia in Childhood)’. British Journal of Haematology, vol. 78, no. 2, Wiley, June 1991, pp. 187–196, https://doi.org10.1111/j.1365-2141.1991.tb04415.x.
[15] Shahverdi, E. ‘Treatment-Related Complications in Childhood Acute Lymphoblastic Leukemia: Results of Medical Research Council UKALL X’. Middle East Journal of Cancer, vol. 11, no. 2, 2020, pp. 168–173.
[16] Reisi, Nahid, et al. ‘The Metabolic Syndrome in Survivors of Childhood Acute Lymphoblastic Leukemia in Isfahan, Iran’. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, vol. 14, no. 2, Mar. 2009, pp. 111–116, https://www.ncbi.nlm.nih.gov/pubmed/21772869.
[17] Namazi, Soha, et al. ‘Evaluating the Effect of 3 Glucocorticoid Receptor Gene Polymorphisms on Risk of Relapse in 100 Iranian Children with Acute Lymphoblastic Leukemia: A Case-Control Study’. Clinical Therapeutics, vol. 33, no. 3, Elsevier BV, Mar. 2011, pp. 280–290, https://doi.org10.1016/j.clinthera.2011.03.004.
[18] Motaghi, M., et al. ‘Comparative Effect of Chamomile Mouthwash and Topical Mouth Rinse in Prevention of Chemotherapy-Induced Oral Mucositis in Iranian Pediatric Patients with Acute Lymphoblastic Leukemia’. Iranian Journal of Blood and Cancer, vol. 9, no. 3, 2017, pp. 84–88.
[19] Myles, Anthony J., et al. ‘An Introduction to Decision Tree Modeling’. Journal of Chemometrics, vol. 18, no. 6, Wiley, June 2004, pp. 275–285, https://doi.org10.1002/cem.873.
[20] Liu, Anthony Pak-Yin, et al. ‘Treatment Barriers and Clinical Outcome of Children with Medulloblastoma in China: A Report from the Chinese Children’s Cancer Group (CCCG)’. Neuro-Oncology Advances, vol. 3, no. 1, Oxford University Press (OUP), Jan. 2021, p. vdab134, https://doi.org10.1093/noajnl/vdab134.
[21] Yang, Wenyu, et al. ‘Pulse Therapy with Vincristine and Dexamethasone for Childhood Acute Lymphoblastic Leukaemia (CCCG-ALL-2015): An Open-Label, Multicentre, Randomised, Phase 3, Non-Inferiority Trial’. The Lancet Oncology, vol. 22, no. 9, Elsevier BV, Sept. 2021, pp. 1322–1332, https://doi.org10.1016/S1470-2045(21)00328-4.
[22] Ameri, Hosein, et al. ‘Interim Value Set for the EQ-5D-5L in Iran Using the Crosswalk Method’. Medical Journal of the Islamic Republic of Iran, vol. 34, Sept. 2020, p. 121, https://doi.org10.34171/mjiri.34.121.
[23] Goudarzi, Reza, et al. ‘Population-Based Preference Weights for the EQ-5D Health States Using the Visual Analogue Scale (VAS) in Iran’. Iranian Red Crescent Medical Journal, vol. 18, no. 2, DoNotEdit, Feb. 2016, p. e21584, https://doi.org10.5812/ircmj.21584.
[24] Kiadaliri, Aliasghar A. ‘A Comparison of Iran and UK EQ-5D-3L Value Sets Based on Visual Analogue Scale’. International Journal of Health Policy and Management, vol. 6, no. 5, Maad Rayan Publishing Company, Sept. 2016, pp. 267–272, https://doi.org10.15171/ijhpm.2016.131.
[25] Bartram, J., et al. ‘Improvements in Outcome of Childhood Acute Lymphoblastic Leukaemia (ALL) in the UK-a Success Story of Modern Medicine through Successive UKALL Trials and International Collaboration’. British Journal of Haematology, vol. 191, no. 4, 2020, pp. 562–567.
[26] Pui, Ching-Hon, et al. ‘Global Efforts toward the Cure of Childhood Acute Lymphoblastic Leukaemia’. The Lancet. Child & Adolescent Health, vol. 2, no. 6, Elsevier BV, June 2018, pp. 440–454, https://doi.org10.1016/S2352-4642(18)30066-X.
[27] Rae, C., et al. ‘Economic Evaluation of Treatment for Acute Lymphoblastic Leukaemia in Childhood’. European Journal of Cancer Care, vol. 23, no. 6, Hindawi Limited, Nov. 2014, pp. 779–785, https://doi.org10.1111/ecc.12173.
[28] Fardell, Joanna E., et al. ‘Health-Related Quality of Life of Children on Treatment for Acute Lymphoblastic Leukemia: A Systematic Review’. Pediatric Blood & Cancer, vol. 64, no. 9, Wiley, Sept. 2017, p. e26489, https://doi.org10.1002/pbc.26489.
[29] McGrady, Meghan E., et al. ‘Cost-Effectiveness Analysis of an Adherence-Promotion Intervention for Children with Leukemia: A Markov Model-Based Simulation’. Journal of Pediatric Psychology, vol. 43, no. 7, Oxford University Press (OUP), Aug. 2018, pp. 758–768, https://doi.org10.1093/jpepsy/jsy022.
[30] Maser, Brandon, et al. ‘Levofloxacin Prophylaxis in Hospitalized Children with Leukemia: A Cost-Utility Analysis’. Pediatric Blood & Cancer, vol. 67, no. 10, Wiley, Oct. 2020, p. e28643, https://doi.org10.1002/pbc.28643.
[31] Gupta, Sumit, et al. ‘Health Care Utilisation and Costs Associated with Different Treatment Protocols for Newly Diagnosed Childhood Acute Lymphoblastic Leukaemia: A Population-Based Study in Ontario, Canada’. European Journal of Cancer (Oxford, England: 1990), vol. 151, Elsevier BV, July 2021, pp. 126–135, https://doi.org10.1016/j.ejca.2021.04.006.
[2] Hayati, Hadi, Abbas Kebriaeezadeh, Mohammad-Ali Ehsani, et al. ‘Cost-Analysis of Treatment of Childhood Acute Lymphoblastic Leukemia Based on UKALL Protocol’. Iranian Journal of Pediatrics, vol. In Press, no. In Press, Briefland, Sept. 2018, https://doi.org10.5812/ijp.7985.
[3] Conter, V., M. Aricò, M. G. Valsecchi, et al. ‘Extended Intrathecal Methotrexate May Replace Cranial Irradiation for Prevention of CNS Relapse in Children with Intermediate-Risk Acute Lymphoblastic Leukemia Treated with Berlin-Frankfurt-Münster-Based Intensive Chemotherapy. The Associazione Italiana Di Ematologia Ed Oncologia Pediatrica’. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, vol. 13, no. 10, American Society of Clinical Oncology (ASCO), Oct. 1995, pp. 2497–2502, https://doi.org10.1200/JCO.1995.13.10.2497.
[4] Hayati, Hadi, Abbas Kebriaeezadeh, Mohammad Ali Ehsani, et al. ‘Cost-Utility of Protocols of BFM-ALL and UK-ALL for Treatment of Children with Acute Lymphoblastic Leukemia in Iran’. Iranian Journal of Public Health, vol. 47, no. 3, Mar. 2018, pp. 407–412, https://www.ncbi.nlm.nih.gov/pubmed/29845029.
[5] Hayati, Hadi. ‘Comparison of the Unit Cost of Diagnostic Imaging Services before and during the COVID-19 Pandemic Using the Activity-Based Costing (ABC) Method’. Iranian Journal of Radiology: A Quarterly Journal Published by the Iranian Radiological Society, vol. 19, no. 3, Briefland, Oct. 2022, https://doi.org10.5812/iranjradiol-123781.
[6] Schrappe, M. ‘A Cost Comparison Analysis of Paediatric Intermediate Care in a Tertiary Hospital and an Intermediate Care Facility in Cape Town’. Plos One, no. 12, South Africa, 2000.
[7] Duncan, Kristal, and Edina Sinanovic. ‘A Cost Comparison Analysis of Paediatric Intermediate Care in a Tertiary Hospital and an Intermediate Care Facility in Cape Town, South Africa’. PloS One, vol. 14, no. 4, Public Library of Science (PLoS), Apr. 2019, p. e0214492, https://doi.org10.1371/journal.pone.0214492.
[8] Doshmangir, Leila, et al. ‘Correction to: Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta‑analysis’. Applied Health Economics and Health Policy, vol. 19, no. 6, Springer Science and Business Media LLC, Nov. 2021, p. 953, https://doi.org10.1007/s40258-021-00686-w.
[9] James, S. L. ‘Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study’. The Lancet, vol. 392, 1990, pp. 1789–1858.
[10] ---. ‘Prevention of CNS Recurrence in Childhood ALL: Results with Reduced Radiotherapy Combined with CNS-Directed Chemotherapy in Four Consecutive ALL-BFM Trials’. Klinische Padiatrie, vol. 210, no. 4, Georg Thieme Verlag KG, July 1998, pp. 192–199, https://doi.org10.1055/s-2008-1043878.
[11] Conter, V., M. Aricò, G. Basso, et al. ‘Long-Term Results of the Italian Association of Pediatric Hematology and Oncology (AIEOP) Studies 82, 87, 88, 91 and 95 for Childhood Acute Lymphoblastic Leukemia’. Leukemia, vol. 24, no. 2, Springer Science and Business Media LLC, Feb. 2010, pp. 255–264, https://doi.org10.1038/leu.2009.250.
[12] Eden, O. B., G. Harrison, et al. ‘Long-Term Follow-up of the United Kingdom Medical Research Council Protocols for Childhood Acute Lymphoblastic Leukaemia, 1980–1997’. Leukemia, vol. 14, no. 12, Springer Science and Business Media LLC, Dec. 2000, pp. 2307–2320, https://doi.org10.1038/sj.leu.2401962.
[13] Mitchell, C., et al. ‘Long-Term Follow-up of the United Kingdom Medical Research Council Protocols for Childhood Acute Lymphoblastic Leukaemia, 1980-2001’. Leukemia, vol. 24, no. 2, Springer Science and Business Media LLC, Feb. 2010, pp. 406–418, https://doi.org10.1038/leu.2009.256.
[14] Eden, O. B., J. S. Lilleyman, et al. ‘Results of Medical Research Council Childhood Leukaemia Trial UKALL VIII (Report to the Medical Research Council on Behalf of the Working Party on Leukaemia in Childhood)’. British Journal of Haematology, vol. 78, no. 2, Wiley, June 1991, pp. 187–196, https://doi.org10.1111/j.1365-2141.1991.tb04415.x.
[15] Shahverdi, E. ‘Treatment-Related Complications in Childhood Acute Lymphoblastic Leukemia: Results of Medical Research Council UKALL X’. Middle East Journal of Cancer, vol. 11, no. 2, 2020, pp. 168–173.
[16] Reisi, Nahid, et al. ‘The Metabolic Syndrome in Survivors of Childhood Acute Lymphoblastic Leukemia in Isfahan, Iran’. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, vol. 14, no. 2, Mar. 2009, pp. 111–116, https://www.ncbi.nlm.nih.gov/pubmed/21772869.
[17] Namazi, Soha, et al. ‘Evaluating the Effect of 3 Glucocorticoid Receptor Gene Polymorphisms on Risk of Relapse in 100 Iranian Children with Acute Lymphoblastic Leukemia: A Case-Control Study’. Clinical Therapeutics, vol. 33, no. 3, Elsevier BV, Mar. 2011, pp. 280–290, https://doi.org10.1016/j.clinthera.2011.03.004.
[18] Motaghi, M., et al. ‘Comparative Effect of Chamomile Mouthwash and Topical Mouth Rinse in Prevention of Chemotherapy-Induced Oral Mucositis in Iranian Pediatric Patients with Acute Lymphoblastic Leukemia’. Iranian Journal of Blood and Cancer, vol. 9, no. 3, 2017, pp. 84–88.
[19] Myles, Anthony J., et al. ‘An Introduction to Decision Tree Modeling’. Journal of Chemometrics, vol. 18, no. 6, Wiley, June 2004, pp. 275–285, https://doi.org10.1002/cem.873.
[20] Liu, Anthony Pak-Yin, et al. ‘Treatment Barriers and Clinical Outcome of Children with Medulloblastoma in China: A Report from the Chinese Children’s Cancer Group (CCCG)’. Neuro-Oncology Advances, vol. 3, no. 1, Oxford University Press (OUP), Jan. 2021, p. vdab134, https://doi.org10.1093/noajnl/vdab134.
[21] Yang, Wenyu, et al. ‘Pulse Therapy with Vincristine and Dexamethasone for Childhood Acute Lymphoblastic Leukaemia (CCCG-ALL-2015): An Open-Label, Multicentre, Randomised, Phase 3, Non-Inferiority Trial’. The Lancet Oncology, vol. 22, no. 9, Elsevier BV, Sept. 2021, pp. 1322–1332, https://doi.org10.1016/S1470-2045(21)00328-4.
[22] Ameri, Hosein, et al. ‘Interim Value Set for the EQ-5D-5L in Iran Using the Crosswalk Method’. Medical Journal of the Islamic Republic of Iran, vol. 34, Sept. 2020, p. 121, https://doi.org10.34171/mjiri.34.121.
[23] Goudarzi, Reza, et al. ‘Population-Based Preference Weights for the EQ-5D Health States Using the Visual Analogue Scale (VAS) in Iran’. Iranian Red Crescent Medical Journal, vol. 18, no. 2, DoNotEdit, Feb. 2016, p. e21584, https://doi.org10.5812/ircmj.21584.
[24] Kiadaliri, Aliasghar A. ‘A Comparison of Iran and UK EQ-5D-3L Value Sets Based on Visual Analogue Scale’. International Journal of Health Policy and Management, vol. 6, no. 5, Maad Rayan Publishing Company, Sept. 2016, pp. 267–272, https://doi.org10.15171/ijhpm.2016.131.
[25] Bartram, J., et al. ‘Improvements in Outcome of Childhood Acute Lymphoblastic Leukaemia (ALL) in the UK-a Success Story of Modern Medicine through Successive UKALL Trials and International Collaboration’. British Journal of Haematology, vol. 191, no. 4, 2020, pp. 562–567.
[26] Pui, Ching-Hon, et al. ‘Global Efforts toward the Cure of Childhood Acute Lymphoblastic Leukaemia’. The Lancet. Child & Adolescent Health, vol. 2, no. 6, Elsevier BV, June 2018, pp. 440–454, https://doi.org10.1016/S2352-4642(18)30066-X.
[27] Rae, C., et al. ‘Economic Evaluation of Treatment for Acute Lymphoblastic Leukaemia in Childhood’. European Journal of Cancer Care, vol. 23, no. 6, Hindawi Limited, Nov. 2014, pp. 779–785, https://doi.org10.1111/ecc.12173.
[28] Fardell, Joanna E., et al. ‘Health-Related Quality of Life of Children on Treatment for Acute Lymphoblastic Leukemia: A Systematic Review’. Pediatric Blood & Cancer, vol. 64, no. 9, Wiley, Sept. 2017, p. e26489, https://doi.org10.1002/pbc.26489.
[29] McGrady, Meghan E., et al. ‘Cost-Effectiveness Analysis of an Adherence-Promotion Intervention for Children with Leukemia: A Markov Model-Based Simulation’. Journal of Pediatric Psychology, vol. 43, no. 7, Oxford University Press (OUP), Aug. 2018, pp. 758–768, https://doi.org10.1093/jpepsy/jsy022.
[30] Maser, Brandon, et al. ‘Levofloxacin Prophylaxis in Hospitalized Children with Leukemia: A Cost-Utility Analysis’. Pediatric Blood & Cancer, vol. 67, no. 10, Wiley, Oct. 2020, p. e28643, https://doi.org10.1002/pbc.28643.
[31] Gupta, Sumit, et al. ‘Health Care Utilisation and Costs Associated with Different Treatment Protocols for Newly Diagnosed Childhood Acute Lymphoblastic Leukaemia: A Population-Based Study in Ontario, Canada’. European Journal of Cancer (Oxford, England: 1990), vol. 151, Elsevier BV, July 2021, pp. 126–135, https://doi.org10.1016/j.ejca.2021.04.006.
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| Issue | Vol 10 No 1 (2024): 10(1) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jppm.v10i1.15397 | |
| Keywords | ||
| Cancer management, Cost, Acute Lymphoblastic Leukemia, Children, Cost- Effectiveness analysis, Decision Tree modelling, BFM-ALL, UK-ALL, QALY | ||
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How to Cite
1.
Hayati H, Ehsani MA. Cost-Effectiveness of the treatment protocols of pediatrics with Acute Lymphoblastic Leukemia (Decision tree modelling). JPPM. 2024;10(1):1-10.
