Resource utilization and cost effectiveness of treating acute promyelocytic leukaemia using generic arsenic trioxide.

Abstract

Arsenic trioxide (ATO)-based regimens are the standard of care for treating acute promyelocytic leukaemia (APL) and have replaced chemotherapy-based approaches. However, the cost of "patented" ATO is prohibitive because of patent rights. "Generic" ATO has been used in a few countries, but its implications for health resource utilization (HRU) and cost of treatment are unknown. We hypothesized that treating APL patients using generic ATO (APL-ATO) will be cost effective compared to the chemotherapy-based regimen (APL-CT). In a single-centre retrospective study, we used a bottom-up costing method to compare the direct medical cost of treatment and HRU between APL-ATO and APL-CT. These costs and the survival and relapse probabilities were imputed in a three-state Markov decision model to estimate the cost effectiveness of APL-ATO compared to APL-CT. The mean cost of treatment for APL-ATO (n=30, $8500±2078) was significantly less than for APL-CT (n=30, $22600±5528) (P<0·001). APL-ATO reduced hospitalization, antibiotic and antifungal usage (P<0·001). In the Markov model, five-year treatment costs were significantly lower for APL-ATO ($11131) than for APL-CT ($17926) (P<0·001). Treatment cost and health resource utilization were significantly lower for generic ATO-treated APL patients compared to the chemotherapy-based regimen.