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Updated: Aug 5, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Cost-Effectiveness of Blinatumomab for Pediatric High-Risk Relapsed Acute Lymphoblastic Leukemia in Brazil: An
Gutemberg Guedes Monte1, Ciliana Rechenmacher2, Amanda Pinhatti2
1School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Translational Pediatrics Laboratory, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
Insights
Blinatumomab offers improved outcomes for pediatric B-cell acute lymphoblastic leukemia patients compared to chemotherapy. This targeted therapy is a cost-effective option within Brazil's public health system.
Area of Science:
- Hematology
- Oncology
- Health Economics
Background:
- Pediatric B-cell acute lymphoblastic leukemia (ALL) poses significant treatment challenges, especially in relapsed, high-risk cases.
- Consolidation chemotherapy is a standard treatment, but its effectiveness in relapsed ALL requires ongoing evaluation.
- Identifying cost-effective therapeutic strategies is crucial for healthcare systems like Brazil's Unified Health System (SUS).
Purpose of the Study:
- To assess the cost-effectiveness of blinatumomab versus consolidation chemotherapy for pediatric patients with high-risk relapsed B-cell ALL.
- To provide an economic evaluation from the perspective of the Brazilian Unified Health System (SUS).
Main Methods:
- A partitioned survival model with a lifetime horizon was employed, incorporating three health states: event-free survival, postevent survival, and death.
- Parametric survival models were fitted using clinical trial data, with treatment effects derived from hazard ratios.
- Real-world data from a Brazilian tertiary public hospital informed cost inputs, resource utilization, and dosing, alongside published utility values.
Main Results:
- Blinatumomab demonstrated superior outcomes, yielding 11.73 life-years and 9.96 quality-adjusted life-years (QALYs) per patient.
- Consolidation chemotherapy resulted in 8.36 life-years and 6.74 QALYs, indicating incremental gains with blinatumomab.
- The incremental cost-effectiveness ratio (ICER) for blinatumomab was R$105,742.26 per QALY gained, falling within acceptable willingness-to-pay thresholds.
Conclusions:
- Blinatumomab is a cost-effective alternative to consolidation chemotherapy for pediatric high-risk relapsed B-cell ALL in Brazil.
- The improved clinical outcomes associated with blinatumomab justify its use within the Brazilian Unified Health System.
- Sensitivity analyses support the robustness of blinatumomab's cost-effectiveness under common willingness-to-pay benchmarks.
Objectives:
To evaluate the cost-effectiveness of blinatumomab compared with consolidation chemotherapy in pediatric patients with high-risk relapsed B-cell acute lymphoblastic leukemia from the perspective of the Brazilian Unified Health System.
Methods:
A partitioned survival model with 3 health states (event-free survival, postevent survival, and death) was developed over a lifetime horizon. Parametric survival models were fitted to clinical trial data from Locatelli et al, and treatment effects were incorporated using hazard ratios under the proportional hazards assumption. Real-world data from a retrospective cohort of pediatric patients treated at a tertiary public hospital were used to inform cost inputs, resource utilization, and dosing assumptions. Health-state utility values were obtained from published literature. Costs and outcomes were discounted at an annual rate of 5%. Parameter uncertainty was assessed through deterministic and probabilistic sensitivity analyses (5000 Monte Carlo simulations).
Results:
Blinatumomab was associated with higher costs and improved outcomes compared with consolidation chemotherapy. Patients treated with blinatumomab achieved 11.73 life-years and 9.96 quality-adjusted life-years (QALYs), compared with 8.36 life-years and 6.74 QALYs with chemotherapy, resulting in incremental gains of 3.37 life-years and 3.22 QALYs. The incremental cost was R$ 340 490.07, yielding an incremental cost-effectiveness ratio of R$ 101 035.63 per life-year gained and an incremental cost-utility ratio of R$ 105 742.26 per QALY gained. Sensitivity analyses confirmed the robustness of these findings, with most probabilistic simulations falling below the willingness-to-pay threshold.
Conclusions:
Blinatumomab is associated with improved clinical outcomes and represents a cost-effective alternative to consolidation chemotherapy for pediatric patients with high-risk relapsed B-cell ALL within the Brazilian Unified Health System under commonly referenced willingness-to-pay thresholds.