Medicine Requirements and Budget Implication for Pediatric Acute Lymphoblastic Leukemia in Indonesia: A Morbidity-Based Approach

Background: Limited availability, high costs, and reliance on imported medicines challenge access to pediatric cancer treatment in Indonesia. For childhood acute lymphoblastic leukemia (ALL), the absence of reliable national quantification data complicates procurement, reimbursement, and budget planning. This study estimated hospital-level and national pharmaceutical requirements for pediatric ALL in Indonesia using a morbidity-based forecasting approach. Methods: A budget impact modeling approach using a morbidity-based pharmaceutical quantification framework was developed to estimate theoretical annual procurement requirements for pediatric ALL. Data were derived from three national cancer referral hospitals during the study reference period (January 2022–October 2023) and supplemented with registry data and national treatment guidelines. Drug quantities were calculated using standardized regimens for standard-risk and high-risk patients, assuming an average body weight of 24 kg and body surface area of 0.8 m 2 . National estimates were extrapolated using disease incidence and risk-group distribution rather than comprehensive national medicine-utilization data. Drug prices were obtained from the national electronic procurement catalogue. The model assumed full completion of standardized treatment regimens without treatment interruptions or dose modifications. Results: Pharmaceutical requirements and expenditure were highly concentrated in a limited number of medicines. The estimated annual national pharmaceutical expenditure was IDR 1.43 billion for standard-risk patients and IDR 4.48 billion for high-risk patients, with a combined budget of IDR 5.91 billion. L-asparaginase accounted for the largest share of expenditure, with annual national costs of IDR 993.3 million for standard-risk patients and IDR 2,885.2 million for high-risk patients. Vincristine and daunorubicin were additional major contributors. Across both risk groups, induction therapy represented the most resource-intensive treatment phase, and the ten highest-cost drug–risk group combinations accounted for approximately 97.8% of total pharmaceutical spending. Conclusion: This study provides the first national morbidity-based estimation of pediatric ALL pharmaceutical requirements and budget implications in Indonesia. The findings highlight key cost drivers and support regimen- and risk-specific forecasting for procurement planning and policy decision-making. Keywords: pediatric acute lymphoblastic leukemia, morbidity-based forecasting, pharmaceutical procurement, budget impact analysis, Indonesia