Xcenda, LLC, Palm Harbor, FL 34685, USA.
Appl Health Econ Health Policy. 2012 Nov 1;10(6):431-40. doi: 10.1007/BF03261877.
Rasburicase is a recombinant urate-oxidase enzyme used to reduce high levels of plasma uric acid (PUA) resulting from tumour lysis syndrome (TLS). Rasburicase reduces PUA levels within 4 hours of administration, thereby minimizing the risk of serious complications from TLS. Treatment pattern analyses indicate rasburicase is often used in combination with allopurinol; however, no studies have evaluated the clinical and economic consequences of this pattern of care. The purpose of this study was to compare hospitalization costs, overall length of stay (LOS), and critical-care LOS in patients receiving rasburicase with or without allopurinol.
Hospital claims data from the Premier Perspective Database™ were used to conduct this retrospective analysis. Patients in the Premier hospital database who were administered rasburicase or combination therapy (rasburicase + allopurinol) within 2 days of hospital admission were eligible for study inclusion. Patients were excluded if they were <18 years of age or received haemodialysis (or any other renal replacement therapy support) on admission. Rasburicase patients were propensity-score-matched to combination therapy patients based on gender, race, hospital type (urban/rural, teaching), provider type, payer type, admission source, use of electrolyte modification therapy, critical-care admission and presence of a cancer diagnosis. Differences in healthcare costs, overall LOS and critical-care LOS were assessed using γ-distributed generalized linear models with a log-link function.
The study population comprised 66 patients receiving rasburicase monotherapy matched to 66 patients receiving combination therapy. Mean age was 62.9 years, and 29% were female. Patients initiated on combination therapy had a shorter mean duration of rasburicase administration than patients initiated on monotherapy (2.1 vs 2.7 days) [p = 0.0059]. Additionally, rasburicase monotherapy incurred an average total cost of $US35 843 per hospitalization, compared with $US46 672 for those receiving combination therapy (p = 0.0820). Rasburicase monotherapy patients also had a shorter mean overall LOS (10.0 days vs 15.4 days; p = 0.0067). The mean critical-care LOS was similar in both cohorts (2.4 days rasburicase vs 2.9 days combination therapy; p = 0.3389).
Examination of claims data showed that combination therapy (rasburicase + allopurinol) trended toward higher total hospitalization costs than rasburicase monotherapy. In addition, combination therapy was associated with significantly longer overall LOS compared with upfront rasburicase monotherapy in patients at risk for developing TLS.
拉布立酶是一种重组尿酸酶酶，用于降低肿瘤溶解综合征（TLS）导致的高血浆尿酸（PUA）水平。拉布立酶在给药后 4 小时内降低 PUA 水平，从而最大限度地降低 TLS 严重并发症的风险。治疗模式分析表明，拉布立酶通常与别嘌醇联合使用；然而，尚无研究评估这种治疗模式的临床和经济后果。本研究旨在比较接受拉布立酶单药治疗或联合治疗（拉布立酶+别嘌醇）的患者的住院费用、总住院时间（LOS）和重症监护 LOS。
使用 Premier 透视数据库™中的医院索赔数据进行这项回顾性分析。在入院后 2 天内接受拉布立酶或联合治疗（拉布立酶+别嘌醇）的 Premier 医院数据库中的患者有资格入组。如果患者年龄<18 岁或入院时接受血液透析（或任何其他肾脏替代治疗支持），则排除在外。根据性别、种族、医院类型（城市/农村、教学）、提供者类型、付款类型、入院来源、电解质调节治疗的使用、重症监护入院和癌症诊断，对拉布立酶患者进行倾向评分匹配联合治疗患者。使用具有对数链接函数的γ分布广义线性模型评估医疗保健费用、总 LOS 和重症监护 LOS 的差异。
研究人群包括 66 名接受拉布立酶单药治疗的患者和 66 名接受联合治疗的患者。平均年龄为 62.9 岁，29%为女性。与接受单药治疗的患者相比，接受联合治疗的患者开始接受拉布立酶治疗的平均持续时间更短（2.1 天对 2.7 天）[p=0.0059]。此外，拉布立酶单药治疗的平均总住院费用为 35843 美元/例，而接受联合治疗的费用为 46672 美元/例（p=0.0820）。拉布立酶单药治疗患者的总 LOS 也明显缩短（10.0 天对 15.4 天；p=0.0067）。两组的重症监护 LOS 相似（拉布立酶 2.4 天，联合治疗 2.9 天；p=0.3389）。
对索赔数据的检查表明，与拉布立酶单药治疗相比，联合治疗（拉布立酶+别嘌醇）的总住院费用呈上升趋势。此外，与 TLS 风险患者的拉布立酶单药治疗相比，联合治疗与显著延长的总 LOS 相关。
