RESUMEN
INTRODUCTION: This study estimated the cost-effectiveness of arsenic trioxide (ATO) added to all-trans retinoic acid (ATRA) when used in first-line acute promyelocytic leukemia (APL) treatment. MATERIALS AND METHODS: A Markov cohort model was developed with 3 states: stable disease (during first- or second-line treatment), disease event, and death. Newly diagnosed patients with low- to intermediate-risk APL were included and each month could remain in their current health state or move to another. Treatment consisted of ATO + ATRA, ATRA + idarubicin (IDA), or ATRA + cytarabine (AraC) + additional chemotherapy. After an initial disease event, patients discontinued first-line therapy and switched to a second-line ATO regimen. Efficacy and safety data were obtained from published trials; quality of life/utility estimates were obtained from the literature; costs were obtained from US data sources. Costs and outcomes over time were used to calculate incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Compared to ATRA + AraC + additional chemotherapy, ATRA + IDA treatment had ICERs of $2933 per life-year (LY) saved and $3122 per quality-adjusted life-year (QALY) gained. Compared to the ATRA + IDA regimen, first-line ATO + ATRA treatment had ICERs of $4512 per LY saved and $5614 per QALY gained. Results were sensitive to changes in pharmacy costs of the ATO + ATRA regimen during consolidation. CONCLUSION: The ATO + ATRA regimen is highly cost-effective compared to ATRA + AraC + additional chemotherapy or ATRA + IDA in the treatment of newly diagnosed low- to intermediate-risk APL patients.
Asunto(s)
Antineoplásicos/uso terapéutico , Arsenicales/uso terapéutico , Leucemia Promielocítica Aguda/tratamiento farmacológico , Óxidos/uso terapéutico , Tretinoina/uso terapéutico , Antineoplásicos/economía , Trióxido de Arsénico , Arsenicales/economía , Estudios de Casos y Controles , Análisis Costo-Beneficio , Humanos , Estimación de Kaplan-Meier , Leucemia Promielocítica Aguda/economía , Leucemia Promielocítica Aguda/mortalidad , Cadenas de Markov , Modelos Económicos , Óxidos/economía , Resultado del Tratamiento , Tretinoina/economía , Estados UnidosRESUMEN
We have demonstrated that oral arsenic (Realgar-Indigo naturalis formula, RIF) plus all-trans retinoic acid (ATRA) is not inferior to intravenous arsenic trioxide (ATO) plus ATRA as the first-line treatment of acute promyelocytic leukemia (APL). To compare the cost-effectiveness of oral and intravenous arsenic, we analyzed the results of 30 patients in each group involved in a randomized controlled trial at our center. The median total medical costs were $13,183.49 in the RIF group compared with $24136.98 in the ATO group (p<0.0001). This difference primarily resulted from the different costs of induction therapy (p=0.016) and maintenance treatment (p<0.0001). The length of hospitalization for the RIF group was significantly lower than that for the ATO group (24 vs. 31 days, p<0.0001) during induction therapy. During maintenance treatment, the estimated medical costs were $2047.14 for each patient in the RIF group treated at home compared with $11273.81 for each patient in the ATO group treated in an outpatient setting (p<0.0001). We conclude that oral RIF plus ATRA significantly reduced the medical costs and length of hospital stay during induction and remission therapy compared with ATO plus ATRA in APL patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/economía , Leucemia Promielocítica Aguda/tratamiento farmacológico , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trióxido de Arsénico , Arsenicales/administración & dosificación , Arsenicales/economía , China , Ahorro de Costo , Análisis Costo-Beneficio , Costos Directos de Servicios , Femenino , Costos de la Atención en Salud , Hospitales Universitarios/economía , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Leucemia Promielocítica Aguda/economía , Quimioterapia de Mantención/economía , Masculino , Persona de Mediana Edad , Óxidos/administración & dosificación , Óxidos/economía , Ensayos Clínicos Controlados Aleatorios como Asunto , Inducción de Remisión , Estudios Retrospectivos , Tretinoina/administración & dosificación , Tretinoina/economía , Adulto JovenRESUMEN
To assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) + all-trans retinoic acid (ATRA) for treating newly diagnosed acute promyelocytic leukaemia (APL), the cost-effectiveness of ATO + ATRA compared to ATRA + idarubicin (IDA) was assessed over a lifetime horizon using a time-dependent Markov model. The model considers four health states: complete remission, treatment failure or relapse, post-failure, and death. Markov cycle length was 1 month for the first 48 months and 1 year thereafter. Efficacy outcomes in terms of event-free survival and overall survival were taken from a head-to-head clinical trial. Costs were associated with drug and administration, adverse events (AEs), treatment of relapses, follow-up visits, and productivity losses. Utilities and disutilities associated with health states and AEs were derived from the literature. Compared to ATRA + IDA, ATRA + ATO is associated with incremental cost-effectiveness ratios (ICERs) of $CAD50,193/quality-adjusted life years (QALY) and $CAD50,338/QALY from a Canadian Ministry of Health (MoH) and societal perspectives, respectively. Results of the one-way sensitivity analysis show that ICER varied from $CAD23,045 to $CAD60,759/QALY (MoH perspective) and from $CAD23,120 to $CAD60,905/QALY (societal perspective). ATO in the first-line therapy for patients with APL can be considered a more cost-effective strategy than standard treatment from a Canadian perspective.
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Arsenicales/economía , Análisis Costo-Beneficio/métodos , Leucemia Promielocítica Aguda/tratamiento farmacológico , Óxidos/economía , Trióxido de Arsénico , Arsenicales/uso terapéutico , Canadá , Femenino , Humanos , Masculino , Óxidos/uso terapéuticoAsunto(s)
Antineoplásicos/uso terapéutico , Arsenicales/uso terapéutico , Leucemia Promielocítica Aguda/tratamiento farmacológico , Óxidos/uso terapéutico , Patentes como Asunto , Adulto , Animales , Antineoplásicos/economía , Antineoplásicos/normas , Trióxido de Arsénico , Arsenicales/economía , Arsenicales/normas , China , Humanos , Óxidos/economía , Óxidos/normas , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Displacement damage (DD) caused by fast neutrons in unbiased Gallium Arsenide (GaAs) light emitting diodes (LED) resulted in a reduction of the light output. On the other hand, a similar type of LED irradiated with gamma rays from a (60)Co source up to a dose level in excess of 1.0 kGy (1.0 x 10(5) rad) was found to show no significant drop of the light emission. This phenomenon was used to develop a low cost passive fluence monitor and kinetic energy released per unit mass dosemeter for accelerator-produced neutrons. These LED-dosemeters were used to assess the integrated fluence of photoneutrons, which were contaminated with a strong bremsstrahlung gamma-background generated by the 730 MeV superconducting electron linac driving the free electron laser in Hamburg (FLASH) at Deutsches Elektronen-Synchrotron. The applications of GaAs LED as a routine neutron fluence monitor and DD precursor for the electronic components located in high-energy accelerator environment are highlighted.
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Arsenicales/efectos de la radiación , Galio/efectos de la radiación , Iluminación/instrumentación , Neutrones , Fotometría/instrumentación , Monitoreo de Radiación/instrumentación , Protección Radiológica/instrumentación , Semiconductores , Arsenicales/economía , Diseño Asistido por Computadora , Diseño de Equipo , Análisis de Falla de Equipo , Galio/economía , Alemania , Iluminación/economía , Fotometría/economía , Dosis de Radiación , Monitoreo de Radiación/economía , Monitoreo de Radiación/métodos , Protección Radiológica/economía , Protección Radiológica/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
In a study observing the effect of spirulina in the treatment of chronic arsenic poisoning quantitative estimation of arsenic in the urine of the patients was necessary. It was decided to try a modification of the arsine generator in the process. An alternative apparatus was designed following the structure of arsine generator by White (1976) using a 50-ml conical flask with rubber cork, 4-ml injection vial, two 3" long glass tubes and a glass test tube. An experiment was carried out with solutions containing known amounts of arsenic. The alternative arsine generator was tried in the estimation of arsenic content in those solutions. The results revealed that the apparatus permitted correct measurement of arsenic concentration. The alternative arsine generator was cheap easy to use and provided authentic results in estimation of arsenic concentration in the urine of patients with chronic arsenic poisoning.