medigraphic.com

2022, Number 1

<< Back Next >>

Rev Hematol Mex 2022; 23 (1)

Costs of medical care of relapsed or refractory acute lymphoblastic leukemia in adult patients in health sector in Mexico

Guzmán-Caniupan JA, Carlos-Rivera F, Aubry MT, García-Fernández L, Camacho-Cordero LM, Fascinetto-Dorantes R, Meillon-García LA, Hernández-Garduño AG

Language: Spanish
References: 34
Page: 36-47
PDF size: 233.74 Kb.


ABSTRACT

Objective: To determine the costs of institutional care in adult patients with relapsed or refractory acute lymphoblastic leukemia in Mexico.
Materials and Methods: A retrospective study was done applying a questionnaire to eight experts in the care of adult patients with relapsed or refractory acute lymphoblastic leukemia, to determine the costs of routine medical care, the costs related to the IDA-FLAG treatment scheme (idarubicin, fludarabine, cytarabine, and colony-stimulating factor), which included the costs of adverse events and the costs of end-stage care. Costs were reported in Mexican pesos (MXN).
Results: The estimated total annual cost of care for an adult patient with relapsed or refractory acute lymphoblastic leukemia responder was $332,381, and in non-responder patients, $972,599. Responders compared to non-responder patients reported: routine care expenses (outpatient and inpatient care) $102,844 vs $727,363; the cost of the IDA-FLAG scheme was $229,537 vs $175,398. The estimated weighted average cost of terminal care at the hospital level was $69,838.
Conclusions: Total care costs in adult patients with relapsed or refractory acute lymphoblastic leukemia are increased three times in non-responders than in responder patients. Innovative interventions to reduce relapses should be considered.


REFERENCES

  1. National Cancer Institute: Cancer Stat Facts: Leukemia: Acutelymphocytic leukemia (ALL). Disponible en: https://seer.cancer.gov/statfacts/html/alyl.html. [Acceso noviembre 3, 2021].

  2. INEGI. Estadísticas de mortalidad y población 2020. Disponibleen: https://www.inegi.org.mx/temas/mortalidad/.[Acceso febrero 22, 2022].

  3. Santoyo-Sánchez A, Ramos-Peñafiel CO, Saavedra-GonzálezA, González-Almanza L, Martínez-Tovar A, Olarte-CarrilloI, et al. Frecuencias de edad y género de pacientes conleucemia observada en dos centros de referencia del Vallede México. Gac Med Mex 2016; 152: 208-12.

  4. Fielding AK, Richards SM, Chopra R, Lazarus HM, LitzowMR, Buck G, et al. Medical Research Council of the UnitedKingdom Adult ALL Working Party; Eastern CooperativeOncology Group. Outcome of 609 adults after relapse ofacute lymphoblastic leukemia (ALL); an MRC UKALL12/ECOG 2993 study. Blood 2007; 109 (3): 944-50. doi:10.1182/blood-2006-05-018192.

  5. O'Brien S, Thomas DA, Ravandi F, Faderl S, Pierce S, KantarjianH. Results of the hyperfractionated cyclophosphamide,vincristine, doxorubicin, and dexamethasone regimen inelderly patients with acute lymphocytic leukemia. Cancer2008; 113 (8): 2097-101. doi: 10.1002/cncr.23819.

  6. Sive JI, Buck G, Fielding A, Lazarus HM, Litzow MR, Luger S,et al. Outcomes in older adults with acute lymphoblasticleukaemia (ALL): results from the international MRC UKALLXII/ECOG2993 trial. Br J Haematol 2012; 157 (4): 463-71.doi: 10.1111/j.1365-2141.2012.09095.x.

  7. Gökbuget N, Beck J, Brüggemann M, Burmesister T, BussEC, Frickhofen N, et al. Moderate intensive chemotherapyincluding CNS-prophylaxis with liposomal cytarabine isfeasible and effective in older patients with Ph-negativeacute lymphoblastic leukemia (ALL): Results of a prospectivetrial from the German Multicenter Study Group forAdult ALL (GMALL). Blood 2012; 120: 2012 (abstr 1493a).

  8. Roberts KG, Gu Z, Payne-Turner D, McCastlain K, HarveyRC, Chen IM, et al. High frequencyand poor outcome ofPhiladelphia chromosome-like acute lymphoblastic leukemiain adults. J Clin Oncol 2017; 35: 394-401. doi: 10.1200/JCO.2016.69.0073.

  9. Kozlowski P, Lennmyr E, Ahlberg L, Bernell P, HulegårdhE, Karbach H, et al. Swedish Adult Acute LymphoblasticLeukemia Group (SVALL). Age but not Philadelphia positivityimpairs outcome in older/elderly patients with acutelymphoblastic leukemia in Sweden. Eur J Haematol 2017;99 (2): 141-149. doi: 10.1111/ejh.12896.

  10. Geyer MB, Hsu M, Devlin SM, Tallman MS, Douer D, ParkJH. Overall survival among older US adults with ALL remainslow despite modest improvement since 1980: SEERanalysis. Blood 2017; 129 (13): 1878-1881. doi: 10.1182/blood-2016-11-749507.

  11. Bassan R, Hoelzer D. Modern therapy of acute lymphoblasticleukemia. J Clin Oncol 2011; 29 (5): 532-543. doi:10.1200/JCO.2010.30.1382.

  12. van Dongen JJ, van der Velden VH, Brüggemann M, OrfaoA. Minimal residual disease diagnostics in acute lymphoblasticleukemia: need for sensitive, fast, and standardizedtechnologies. Blood 2015; 125 (26): 3996-4009. doi:10.1182/blood-2015-03-580027.

  13. Gökbuget N, Kneba M, Raff T, Trautmann H, Bartram CR,Arnold R, et al. German Multicenter Study Group for AdultAcute Lymphoblastic Leukemia. Adult patients with acutelymphoblastic leukemia and molecular failure display apoor prognosis and are candidates for stem cell transplantationand targeted therapies. Blood 2012; 120 (9):1868-76. doi: 10.1182/blood-2011-09-377713.

  14. Gökbuget N, Dombret H, Giebel S, Bruggemann M, DoubekM, Foà R, et al. Minimal residual disease level predictsoutcome in adults with Ph-negative B-precursor acutelymphoblastic leukemia. Hematology. 2019; 24 (1): 337-348. doi: 10.1080/16078454.2019.1567654.

  15. Dinmohamed AG, Szabó A, van der Mark M, Visser O,Sonneveld P, Cornelissen JJ, et al. Improved survival inadult patients with acute lymphoblastic leukemia in theNetherlands: a population-based study on treatment, trialparticipation and survival. Leukemia 2016; 30 (2): 310-7.doi: 10.1038/leu.2015.230.

  16. Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, RichardsSM, et al. ECOG; MRC/NCRI Adult Leukemia WorkingParty. Induction therapy for adults with acute lymphoblasticleukemia: results of more than 1500 patients from theinternational ALL trial: MRC UKALL XII/ECOG E2993. Blood2005; 106 (12): 3760-7. doi: 10.1182/blood-2005-04-1623.

  17. Gökbuget N, Hoelzer D, Arnold R, Böhme A, Bartram CR,Freund M, et al. Treatment of adult ALL according to protocolsof the German Multicenter Study Group for AdultALL (GMALL). Hematol Oncol Clin North Am 2000; 14 (6):1307-25. doi: 10.1016/s0889-8588(05)70188-x.

  18. Thomas X, Boiron JM, Huguet F, Dombret H, BradstockK, Vey N, et al. Outcome of treatment in adults withacute lymphoblastic leukemia: analysis of the LALA-94trial. J Clin Oncol 2004; 22 (20): 4075-86. doi: 10.1200/JCO.2004.10.050.

  19. Bassan R, Spinelli O, Oldani E, Intermesoli T, Tosi M, PerutaB, et al. Improved risk classification for risk-specifictherapy based on the molecular study of minimal residualdisease (MRD) in adult acute lymphoblastic leukemia(ALL). Blood 2009; 113 (18): 4153-62. doi: 10.1182/blood-2008-11-185132.

  20. Pullarkat V, Slovak ML, Kopecky KJ, Forman SJ, AppelbaumFR. Impact of cytogenetics on the outcome of adult acutelymphoblastic leukemia: results of Southwest OncologyGroup 9400 study. Blood 2008; 111 (5): 2563-72. doi:10.1182/blood-2007-10-116186.

  21. Ramos-Peñafiela CO, Martínez-Tovar A, Olarte-Carrillo I,Castellanos-Sinco H, Martínez-Murillo C, y col. Experienciadel tratamiento de la leucemia linfoide aguda en recaídaen el Hospital General de México. Rev Med Hosp Gen Mex2010; 73 (4): 263-267.

  22. Kaul S, Korgenski EK, Ying J, Ng CF, Smits-Seemann RR, NelsonRE, et al. A retrospective analysis of treatment-relatedhospitalization costs of pediatric, adolescent, and youngadult acute lymphoblastic leukemia. Cancer Med 2016; 5(2): 221-9. doi: 10.1002/cam4.583.

  23. Enuvo GmbH, Seefeldstrasse 25, 8008 Zurich, Switzerland.Disponible en: https://www.onlineencuesta.com/[junio, 2021].

  24. Diagnóstico y Tratamiento Leucemia Linfoblástica Agudaen el Adulto. Guía de Evidencias y Recomendaciones: Guíade Práctica Clínica. México, Instituto Mexicano del SeguroSocial, 2018.

  25. Instituto Mexicano del Seguro Social.- Secretaría del HonorableConsejo Técnico. ACUERDO número ACDO.AS3.HCT.301120/310.P.DF dictado por el H. Consejo Técnico,en sesión ordinaria de 30 de noviembre de 2020, relativoa la Aprobación de los Costos Unitarios por Nivel deAtención Médica actualizados al año 2021. Diario Oficialde la Federación 28/12/2020. Disponible en: https://www.dof.gob.mx/nota_detalle.php?codigo=5608945&fecha=28/12/2020 [acceso agosto 30, 2021].

  26. Specchia G, Pastore D, Carluccio P, Liso A, Mestice A, RizziR, et al. FLAG-IDA in the treatment of refractory/relapsedadult acute lymphoblastic leukemia. Ann Hematol 2005;84 (12): 792-5. doi: 10.1007/s00277-005-1090-9.

  27. Secretaría de Hacienda. Programa Anual de Adquisiciones,Arrendamientos y Servicios y Obra Pública (PAAASOP2021). Disponible en: https://procura-compranet.hacienda.gob.mx/paaasopdashboard/-. [acceso agosto 30, 2021].

  28. Instituto Nacional de Transparencia Acceso a la Informacióny Protección de Datos Personales (INAI). Solicitud deconsulta pública, No. 0064100241120-2. Disponible en:https://home.inai.org.mx/ [acceso agosto 30, 2021].

  29. INEGI. Calculadora de Inflación. Disponible en:https://www.inegi.org.mx/app/indicesdeprecios/calculadorainflacion.aspx. [acceso agosto 30, 2021].

  30. Arroyave LMG, Ramírez NRF, Amador VL. Grupos Relacionadoscon el Diagnóstico: Producto Hospitalario GRD-IMSS2017. Instituto Mexicano del Seguro Social. Disponible en:http://www.imss.gob.mx/sites/all/statics/profesionalesSalud/economia/Libro-GRD2017.pdf. [acceso agosto 30, 2021].

  31. Dirección General de Información en Salud (DGIS). Cubos dinámicosde Egresos Hospitalarios. Sector Salud (SSa, IMSS, IMSSOportunidades,ISSSTE, PEMEX, SEDENA, SEMAR, Otros).Instituciones Públicas morbilidad. 2008 a 2017. Disponibleen http://www.dgis.salud.gob.mx/ contenidos/basesdedatos/std_egresoshospitalarios.html. [acceso agosto, 2021].

  32. Instituto Nacional de Estadística, Geografía e Informática(INEGI). Mortalidad, defunciones registradas, 2008-2017.Disponible en: https://www.inegi.org.mx/programas/mortalidad/. [acceso agosto 30, 2021].

  33. Dombret H, Thomas X, Chevallier P, Nivot E, Reitan J,Barber B, et al. Healthcare burden and reimbursementof hospitalization during chemotherapy for adults withPh-negative relapsed or refractory B-cell precursoracute lymphoblastic leukemia in France: a retrospectivechart review. J Med Econ 2016; 19 (11): 1034-1039. doi:10.1080/13696998.2016.1192549.

  34. Newton N, McCann J, Welner SA, El Ougari K. High riskacute lymphoblastic leukemia (ALL) in adults and children.Blood 2008; 112 (11): 4659.




2020     |     www.medigraphic.com