Acute Lymphoblastic Leukaemia’s Burden Of Disease In Portugal

Abstract

Acute lymphoblastic leukaemia (ALL) is a haematological malignancy with a rapid progression, affecting both children and adults. Although rare, it is the most common leukaemia in childhood. The main objective of this study was to estimate the burden of disease impact of ALL measured by Disability Adjusted Life Years (DALY) in Portugal, for 2015. DALY combines Years Lost due to Disability (YLD), and Years of Life Lost (YLL) due to premature death. Deaths due to ALL were estimated based on lymphoblastic leukaemia (LL) mortality data from national statistics. The disability weights used to estimate YLD were based on the 2015 Global Burden of Disease (GBD 2015). Four disease states were considered: 1) diagnosis and primary therapy; 2) controlled disease; 3) relapsed/refractory disease; and 4) terminal phase. The incidence of states 1) and 4) was based on national registries and statistics for LL, and on international registries for ALL. The incidence of states 2) and 3) was estimated for children and adults separately through partitioned survival models based on clinical trials in ALL patients. State 1) was assumed to last 2 years (experts’ opinion), and other states durations were based on GBD 2015. In 2015, 130 new ALL cases and 58 ALL deaths were estimated to have occurred in Portugal. The total disease burden attributable to ALL was estimated at 1,039 DALY, with 89% due to YLL and the remaining due to YLD. Per average ALL patient, a burden of 1.78 DALY was estimated. Children and adults share YLD equally, but 69% of YLL took place in adults. ALL is an important cause of disease burden, both in children and adults, with a higher impact on YLL in Portuguese adults. ALL is therefore an important target for health policy interventions due to its burden by average patient.