Inclusion of pegaspargase in multidrug chemotherapy was found to be both cost-effective and efficacious as first-line treatment for patients with acute lymphoblastic leukemia (ALL), according to a recent analysis published in the journal Health Economics Review.

The UK National Institute for Health and Care Excellence Technology Appraisal Committee, using the results of this analysis, recommended pegaspargase as a cost-effective treatment for newly diagnosed, untreated ALL in patients across age groups.

The enzyme asparaginase breaks down asparagine and can be used in treatment of ALL by exploiting the inability of ALL blasts to produce asparagine. Pegaspargase is an Escherichia coli-based asparaginase that has been pegylated and can be used as a therapy for ALL.

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The analysis was based on information from 3 UK-based clinical trials in patients with ALL spanning different age groups. These were the UKALL 2011 (EU Clinical Trials Register Number: 2010–020924-22), UKALL 2003 (EU Clinical Trials Register Number: 2007–004013-34), and UKALL14 (EU Clinical Trials Register Number: 2009–012717-22) trials.

Using the trial data, the researchers evaluated first-line treatment costs and outcomes for pegaspargase in comparison with native asparaginase from Erwinia chrysanthemi. Comparisons were based on a model developed using decision tree and Markov modeling approaches.

The use of first-line pegaspargase was associated with an overall cost reduction of £4741 in comparison with native asparaginase. Pegaspargase showed an improvement in quality-adjusted life-years of 0.0504 compared with native asparaginase. In terms of the incremental cost-effectiveness ratio, pegaspargase was considered the dominant therapy, and pegaspargase was favored in analyses of multiple scenarios.

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According to the researchers, factors likely contributing to greater cost-effectiveness with pegaspargase include its reduced association with hypersensitivity reactions and its less-frequent administration compared with native asparaginase.

The researchers wrote in their report that “first-line use of pegaspargase could be the key to cost-effective asparaginase treatment of ALL.”


Hu X, Wildman KP, Basu S, Lin PL, Rowntree C, Saha V. The cost-effectiveness of pegaspargase versus native asparaginase for first-line treatment of acute lymphoblastic leukaemia: a UK-based cost-utility analysis. Health Econ Rev. 2019;9(1):40.