Glucarpidase for Treating Adults with Delayed Methotrexate Elimination Due to Impaired Renal Function: An Economic...

Area of Science:

• Pharmacoeconomics
• Oncology
• Nephrology

Background:

• Glucarpidase treats delayed methotrexate elimination in patients with impaired renal function.
• Despite its efficacy, glucarpidase cost is a barrier, with limited economic analyses available.
• This study addresses the economic value of glucarpidase compared to alternative treatments.

Purpose of the Study:

• To assess the economic value of glucarpidase in US adult patients with delayed methotrexate elimination due to renal dysfunction.
• To compare the costs and clinical outcomes of glucarpidase versus other treatment strategies.

Main Methods:

• A decision tree model simulated short-term inpatient management and long-term survival.
• Compared costs of glucarpidase (timely vs. delayed) against hemodialysis and supportive care (SC).
• Evaluated current practice versus a proposed practice of timely glucarpidase administration within 60 hours for eligible patients.

Main Results:

• Proposed practice (timely glucarpidase) increased costs by $20,024 per patient versus current practice, excluding reimbursement.
• Early glucarpidase (within 60 hours) was cheaper than delayed glucarpidase or hemodialysis, but more expensive than SC alone.
• Proposed practice yielded significant clinical benefits, including reduced hospital length of stay.

Conclusions:

• Administering glucarpidase to all eligible patients within 60 hours improves clinical outcomes but increases per-patient costs.
• Timely glucarpidase administration is more cost-effective than delayed glucarpidase or hemodialysis.
• Economic evaluations are crucial for understanding glucarpidase's value in managing delayed methotrexate elimination.