Iranian Journal of Public Health 2018. 47(3):407-412.

Cost-utility of Protocols of BFM-ALL and UK-ALL for Treat-ment of Children with Acute Lymphoblastic Leukemia in Iran



Background: There is a requirement to assess the effectiveness and resources used in two protocols United Kingdom (UK-ALL) and Berlin-Frankfurt-Munster (BFM-ALL) that are most commonly used to treatment of ALL patients by oncologists in Iran. Accordingly, we analyzed the cost of treatment and utility of children treated with two protocols in Iran.

Methods: The entire medical direct costs of patients in "BFM ALL" protocol and "UK ALL" protocol in multi-centers calculated from Apr 2010 to Jun 2015. For calculating utility and Quality Adjusted Life Year (QALY) of the patients, we used standard questionnaire Health Utilities Index 3 (HUI3). The patients and their parents were interviewed. Data were analyzed using software SPSS18 and EXCEL.

Results: The average direct medical cost for each patient for BFM-ALL was 15026 USD and UK-ALL was 8282 USD which showed a significant difference in the total cost of the treatment in the two protocols (P≤0.02). Finally, there was a significant difference in the utility score of the maintenance phase of these two methods (P≤0.003).

Conclusion: UK-ALL is dominant and BFM protocol is dominated by both sides total costs and utility and QALY. Mainly, more hospital stay in "BFM ALL" protocol is the cause of raised costs in this protocol. Consequently, by considering different QALYs in the methods and low costs in "UK ALL" protocol, "UK ALL" protocol is more preferred.




Cost-utility, Acute lymphocytic leukemia, Children, UK-ALL, BFM-ALL

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Scheurer ME, Bondy ML, Gurney JG (2011). Ep-idemiology of childhood cancer. In: Principles and Practice of Pediatric Oncology, 6th ed (eds Pizzo P.A. & Poplack D.G.), 2–16. Lippincott, Williams and Wilkins, Philadelphia, PA, USA.

Hunger SP, Lu X, Devidas M, Camitta BM (2012). Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the Children’s Oncology Group. J Clin Oncol, 30(14):1663-9.

Pui CH, Evans WE (2006). Treatment of acute lymphoblastic leukemia. N Engl J Med, 354(2):166-78.

Pritchard-Jones K, Sullivan R (2013). Children with cancer: driving the global agenda. Lancet Oncol, 14(3):189-91.

Rahiala J, Riikonen P, Kekalainen L, Perkkio M (2000). Cost analysis of the treatment of acute childhood lymphoblastic leukemia according to Nordicprotocols. Acta Paediatr, 89(4):482-7.

TangY, Xu X, Song H (2008). Long-term outcome of childhood acute lymphoblastic leukemia treated in China. Pediatr Blood Cancer, 51(3):380-6.

Mostert S, Sitaresmi MN, Gundy CM et al (2006). Influence of socio-economic status on childhood acute lymphobastic leukemia treatment in Indonesia. Pediatrics, 118(6):e1600-6.

Mostert S, Arora RS, Arreola M, Bagai P et al (2011). Abandonment of treatment for childhood cancer: a position statement of a SIOP PODC Working Group. Lancet Oncol, 12(8):719-20.

Arora RS, Eden T, Pizer B (2007). The problem of treatment abandonment in children from developing countries. Pediatr Blood Cancer, 49(7):941-6.

Liu Y, Chen J, Tang J et al (2009). Cost of childhood acute lymphoblastic leukemia care in Shanghai, China. Pediatr Blood Cancer, 53(4):557-62.

Horsman J, Furlong W, Feeny D, Torrance G (2003). The Health Utilities Index (HUI): Con-cepts, measurement properties and applications. Health Qual Life Outcomes,1: 54.

Barr R, Furlong W, Dawson S et al (1993). An as-sessment of global health status in survivors of acute lymphoblastic leukemia in childhood. Am J Pediatr Hematol Oncol, 15(3):284-90.

Parsons SK, Cohen JT, Lichte ML (2011). Eco-nomic issues in pediatric cancer. In: Principles and Practice of Pediatric Oncology: 6th ed (eds Pizzo P.A. & Poplack D.G.):1428–1440. Lippincott, Williams and Wilkins, Philadelphia, PA, USA.

Taylor R (2001). Using health outcomes data to inform decision-making: government agency perspective. Pharmacoeconomics, 19 Suppl 2:33-8.

Schrappe M, Reiter A, Zimmermann M et al (2000). Long-term results of four consecutive trials in childhood ALL performed by the ALL-BFM study group from 1981 to 1995. Berlin-Frankfurt-Münster. Leukemia, 14(12): 2205-22.

Eden OB, Harrison G, Richards S et al (2000). Long-term follow-up of the United Kingdom Medical Research Council protocols for childhood acute lymphoblastic leukaemia, 1980-1997. Medical Research Council Childhood Leukaemia Working Party. Leukemia, 14(12):2307-20.

Furlong WJ, Feeny DH, Torrance GW, Barr RD (2001). The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies. Ann Med, 33(5):375-84.

Furlong W, Rae CS, Feeny DH et al (2012). Health-Related Quality of Life Among Children With Acute Lymphoblastic Leukemia. Pediatr Blood Cancer, 59(4):717-24.

Central Bank of Iran:

Rae C, Furlong W, Jankovic M et al (2014). Eco-nomic evaluation of treatment for acute lym-phoblastic leukaemia in childhood. Eur J Cancer Care (Engl), 23(6):779-85.

Hayati H, Kebriaeezadeh A, Ehsani MA, et al (2016). Systematic Review of Treatment Costs for Pediatrics Acute Lymphoblastic Leukemia (Comparing Clinical Expenditures in Developed and Developing Countries). Int J Pediatr, 4(12): 4033-41.

Islama A, Akhterb T, Eden C (2015). Cost of treatment for children with acute lymphoblastic leukemia in Bangladesh. J Cancer Policy, 6: 37–43.

Hayati H, Kebriaeezadeh A, Ehsani MA et al (2016). Cost-analysis of Treatment of Pediatrics Acute Lymphoblastic Leukemia based on ALL-BFM Protocol. Int J Pediatr, 4(9): 3381-89.


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