Cost-Effectiveness Analysis of L-Asparaginase versus PEG-Asparaginase in the Treatment Regimen of Acute Lymphoblastic Leukemia

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, with asparaginase-based regimens forming the backbone of therapy. While both PEG-asparaginase and L-asparaginase are commonly employed, they differ significantly in pricing, drug metabolism, and dosing frequency. This study evaluates the economic efficiency of PEG-asparaginase relative to L-asparaginase for pediatric ALL treatment. Method: This pharmacoeconomic evaluation included 55 pediatric ALL patients, with treatment distribution as follows: 50 received PEG-asparaginase, 9 received L-asparaginase, and 4 patients were treated with both agents. Therapeutic efficacy was assessed using an established clinical outcome metric, while direct medical expenditures were systematically documented. The economic evaluation incorporated calculation of the incremental cost-effectiveness ratio (ICER). Statistical comparisons of cost and effectiveness measures were performed using independent sample t-tests, and variable relationships were examined through Pearson correlation analysis. Result: The average cost per patient for PEG-asparaginase was INR. 27,960.00, compared to INR. 2,244.40 for L-asparaginase. Mean effectiveness scores were 0.97 and 0.68, respectively. The ICER for PEG-asparaginase versus L-asparaginase was calculated at INR. 88,674.48 per unit of effectiveness gained. The difference in cost between the two treatments was statistically significant (p = 0.008), while the difference in effectiveness was not (p = 0.436). Pearson correlation analysis indicated a significant positive correlation between drug type and cost (r = 0.525, p < 0.001), but not between cost and effectiveness (r = 0.084, p = 0.529). Conclusion: While PEG-asparaginase demonstrated slightly higher clinical effectiveness, its significantly higher cost did not yield a statistically significant improvement in outcomes over L-asparaginase. These findings suggest that L-asparaginase may offer a more cost-effective option for pediatric ALL treatment, particularly in resource-limited settings. Further research with larger sample sizes is recommended to validate these results.