Abstract
Background: Tumour lysis syndrome is a common complication of haematological malignancies and has historically been managed with hyperhydration, urine alkalinisation and allopurinol with renal dialysis reserved for patients in acute renal failure. Rasburicase has been shown to drastically reduce the need for dialysis; however, its use is limited in developing countries owing to its cost and availability.Aim: This retrospective analysis aimed to compare the cost to state per patient of rasburicase compared to dialysis in the management and prevention of tumour lysis syndrome in paediatric patients presenting with haematological malignancies admitted to Red Cross War Memorial Children’s Hospital (RCWMCH).Setting: Red Cross War Memorial Children’s Hospital.Methods: Patients from two consecutive 35 month periods, before and after the availability of rasburicase at RCWMCH, were grouped according to treatment modality, and the cumulative costs of hospitalisation, dialysis and drug administration were compared.Results: The groups were comparable in mean age and gender. The mean total length of hospital stay was 10.04 days shorter for the rasburicase group than the dialysis group with the average cost per patient in the rasburicase group being R40 989.64 lower than the dialysis group.Conclusion: The use of rasburicase results in a significant per patient cost saving when compared to dialysis, which often requires intensive care admission, and results in extended hospitalisation. The study supports the continued use of rasburicase as an essential adjunct in the management and prevention of tumour lysis syndrome, reaffirming its use as a cost-effective and efficient drug.
Highlights
Tumour lysis syndrome (TLS) and hyperuricaemia are common complications of haematological malignancies and have historically been managed with hyperhydration, urine alkalinisation and allopurinol, with renal dialysis reserved for patients in acute renal failure.[1,2,3,4,5]
Patients were excluded from the study if they had a haematological malignancy that did not require dialysis or rasburicase, any histological diagnoses other than acute leukaemia or non-Hodgkin lymphomas, any pre-existing renal impairment prior to diagnosis from a cause not related to their leukaemia or lymphoma or if they required dialysis for any reason other than TLS
The tumour profile differed slightly between the groups with no T-cell lymphomas being observed in the rasburicase group
Summary
Tumour lysis syndrome (TLS) and hyperuricaemia are common complications of haematological malignancies and have historically been managed with hyperhydration, urine alkalinisation and allopurinol, with renal dialysis reserved for patients in acute renal failure.[1,2,3,4,5] The prevention and management of TLS presents a therapeutic challenge for oncologists treating children with leukaemias and lymphomas in limited-resource settings, owing to cost implications.[6] Randomised control trials have shown that rasburicase, a recombinant form of urate oxidase, is a superior drug for the management of TLS when compared to allopurinol, and while it forms part of standard treatment protocols in certain countries, its availability within our context is limited owing to cost.[7,8]. Rasburicase has been shown to drastically reduce the need for dialysis; its use is limited in developing countries owing to its cost and availability
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