METHODS: This is a single center, retrospective, cohort study. The electronic medical record was used to identify patients receiving rasburicase and to collect baseline demographic and laboratory data. The fixed-dose strategies of rasburicase 1.5 mg and 3 mg were compared in their degree of UA reduction and clinical outcomes. Cost-savings of fixed-dosing was compared to the FDA-approved weight-based dose.
RESULTS: Mean UA reduction in the 1.5 mg group (n = 49) from baseline to 24 hours was 2.88 ± 0.88 mg/dL (p < 0.0001) and 4.83 ± 1.39 mg/dL (p < 0.0001) in the 3 mg group (n = 105). A subgroup analysis of patients who received per protocol initial doses of rasburicase showed a mean reduction in UA from baseline to 24 hours of 2.83 ± 0.62 mg/dL in the 1.5 mg group (n = 42) and 6.12 ± 1.87 mg/dL in the 3 mg group (n = 42). Using a low fixed-dose approach resulted in a cost-savings of $138,077.30 annually.
CONCLUSIONS: Low fixed-dose rasburicase was an effective treatment, with a dose of 1.5 mg being sufficient to reach a goal UA of less than 8 mg/dL for serum UA levels below 12 mg/dL, while a 3 mg dose is appropriate for levels above 12 mg/dL. Cost analysis indicates this strategy is more cost-efficient than the FDA-approved weight-based dose.
方法:这是一个单一的中心,回顾性,队列研究。电子病历用于识别接受rasburicase的患者,并收集基线人口统计学和实验室数据。比较了rasburicase1.5mg和3mg的固定剂量策略的UA降低程度和临床结果。将固定给药的成本节省与FDA批准的基于体重的剂量进行比较。
结果:从基线到24小时,1.5mg组(n=49)的UA平均减少量为2.88±0.88mg/dL(p<0.0001),3mg组(n=105)的UA平均减少量为4.83±1.39mg/dL(p<0.0001)。根据方案初始剂量rasburicase的患者的亚组分析显示,从基线到24小时,在1.5mg组(n=42)和6.12±1.87mg/dL中,UA平均降低了2.83±0.62mg/dL在3mg组(n=42)。使用低固定剂量方法每年节省费用138,077.30美元。
结论:低固定剂量rasburicase是一种有效的治疗方法,对于低于12mg/dL的血清UA水平,1.5mg的剂量足以达到低于8mg/dL的目标UA,而3mg剂量适用于12mg/dL以上的水平。成本分析表明,该策略比FDA批准的基于体重的剂量更具成本效益。