Therapeutic Drug Monitoring and Selective Use of Glucarpidase in High-Dose Methotrexate Therapy: A Cost Analysis From the Algerian Payer Perspective
Author(s)
Farida Bouchenak, PharmD, PhD1, Nardjess Rim Laoufi, PharmD, PhD2, Meriem Hadj M'Hammed, PharmD3, Maroua Hamidi, PharmD3, Idris Abdalli, Jr., PharmD4, Leila Sahraoui, PharmD3, Aissa Bachiri, Professor5, Khaled Sobhi, Professor6.
1Department of Pharmacology, University of Health Sciences, Algiers – Faculty of Pharmacy, Algiers, Algeria, 2Department of Analytical Chemestry, University of Health Sciences, Algiers – Faculty of Pharmacy, Algiers, Algeria, 3University of Health Sciences, Algiers, Algiers, Algeria, 4Ispor Algeria, El Huarache, Algeria, 5University of health sciences, Algiers, Algeria, 6Department of Toxicology, University of Health Sciences, Algiers – Faculty of Pharmacy, Algiers, Algeria.
1Department of Pharmacology, University of Health Sciences, Algiers – Faculty of Pharmacy, Algiers, Algeria, 2Department of Analytical Chemestry, University of Health Sciences, Algiers – Faculty of Pharmacy, Algiers, Algeria, 3University of Health Sciences, Algiers, Algiers, Algeria, 4Ispor Algeria, El Huarache, Algeria, 5University of health sciences, Algiers, Algeria, 6Department of Toxicology, University of Health Sciences, Algiers – Faculty of Pharmacy, Algiers, Algeria.
OBJECTIVES: High-dose methotrexate (HD-MTX ≥500 mg/m²) is commonly used in the treatment of acute leukemia and non-Hodgkin lymphoma, but it is associated with severe toxicities, particularly renal, hepatic, and hematologic, which result in a substantial economic burden, especially in cases of delayed MTX clearance. This study evaluates the annual cost of treating hematologic malignancies with HD-MTX, explores the role of therapeutic drug monitoring (TDM) in managing related toxicities, and simulates the budget impact of introducing glucarpidase as an antidote, from the Algerian payer’s perspective.
METHODS: A retrospective, descriptive study was conducted over 12 months in the Hematology Department in Dr Mohamed Seghir Nekkache Hospital, involving 24 adults treated with HD-MTX for acute leukemia or non-Hodgkin lymphoma. Clinical, laboratory, and economic data were collected. A one-year budget impact analysis from the public payer’s perspective compared two scenarios: without and with glucarpidase introduction in cases of MTX overdose or delayed clearance. Direct medical costs were calculated per patient and per treatment cycle. A sensitivity analysis was performed.
RESULTS: The study recorded 59 HD-MTX cycles; 153 plasma MTX levels were measured at 24, 48, 72 hours, and beyond. The total cost of HD-MTX management without glucarpidase amounted to €87,324. The main cost drivers were hospitalization (47.8%) and chemotherapy (37.7%). Patients with toxic MTX levels at 48 hours incurred 104% higher costs than others. The introduction of glucarpidase, significantly reduced hospitalization duration (from 21 to 9 days) and accelerated renal recovery. This resulted in a 57.14% decrease in hospital-related expenses, although overall costs increased, reaching €63,671 per patient.
CONCLUSIONS: TDM is essential to minimize HD-MTX toxicity and optimize care. Although glucarpidase can reduce hospital stays, its high cost limits its affordability in routine care. Selective use, supported by local pharmacoeconomic data, is needed to guide resource allocation in low- and middle-income countries.
METHODS: A retrospective, descriptive study was conducted over 12 months in the Hematology Department in Dr Mohamed Seghir Nekkache Hospital, involving 24 adults treated with HD-MTX for acute leukemia or non-Hodgkin lymphoma. Clinical, laboratory, and economic data were collected. A one-year budget impact analysis from the public payer’s perspective compared two scenarios: without and with glucarpidase introduction in cases of MTX overdose or delayed clearance. Direct medical costs were calculated per patient and per treatment cycle. A sensitivity analysis was performed.
RESULTS: The study recorded 59 HD-MTX cycles; 153 plasma MTX levels were measured at 24, 48, 72 hours, and beyond. The total cost of HD-MTX management without glucarpidase amounted to €87,324. The main cost drivers were hospitalization (47.8%) and chemotherapy (37.7%). Patients with toxic MTX levels at 48 hours incurred 104% higher costs than others. The introduction of glucarpidase, significantly reduced hospitalization duration (from 21 to 9 days) and accelerated renal recovery. This resulted in a 57.14% decrease in hospital-related expenses, although overall costs increased, reaching €63,671 per patient.
CONCLUSIONS: TDM is essential to minimize HD-MTX toxicity and optimize care. Although glucarpidase can reduce hospital stays, its high cost limits its affordability in routine care. Selective use, supported by local pharmacoeconomic data, is needed to guide resource allocation in low- and middle-income countries.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE731
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology