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Systematic review of costs and cost-effectiveness of treatment for relapsed/refractory acute leukemia in children and young adults

Abstract:
Introduction:
Survival outcomes of children with relapsed/refractory (r/r) acute leukemia remain poor. Novel expensive treatments have been developed to improve their outcomes, yet, limited evidence exists about cost-effectiveness of alternative treatment strategies.
Areas covered:
A systematic review was conducted to summarize health-economic evidence about costs/cost-effectiveness of treating r/r acute leukemia in children/young adults. We searched Medline, Embase, and Cochrane databases until August 13th, 2021. Eligible articles included peer-reviewed original studies addressing r/r pediatric/young-adult acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML). Quality assessment was conducted using Consolidated Health Economics Evaluation Reporting Standards (CHEERS) checklist.
Expert opinion:
The majority of papers focused on CAR-T cell therapy, which is still a novel treatment for r/r ALL, and was found to be cost-effective, yet, there remain concerns over its long-term effectiveness, affordability, and equity in access. The next best treatment option is Blinatumomab, followed by Clofarabine therapy, whereas FLA-IDA salvage chemotherapy provides least value for money. The quality of evidence is moderate to high, with limited generalizability of findings due to high variability in outcomes obtained from modeling studies. Limited studies evaluated r/r AML. We provide recommendations to deliver cost-effective treatments in real-world contexts, with implications for healthcare policy and practice.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1080/17474086.2022.2069096

Authors

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Institution:
University of Oxford
Division:
ContEd
Department:
Continuing Education
Role:
Author
ORCID:
0000-0002-2235-0226
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Primary Care Health Sciences
Oxford college:
Kellogg College
Role:
Author
ORCID:
0000-0002-1009-1992
More by this author
Role:
Author
ORCID:
0000-0001-6619-5291
More by this author
Role:
Author
ORCID:
0000-0002-5105-3140


More from this funder
Funder identifier:
https://ror.org/0187kwz08
Grant:
390


Publisher:
Taylor and Francis Group
Journal:
Expert Review of Hematology More from this journal
Volume:
15
Issue:
4
Pages:
345-357
Place of publication:
England
Publication date:
2022-05-04
Acceptance date:
2022-04-19
DOI:
EISSN:
1747-4094
ISSN:
1747-4086
Pmid:
35485262


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