{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:51:58Z","timestamp":1779893518097,"version":"3.53.1"},"reference-count":49,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T00:00:00Z","timestamp":1618531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>PEG\u2010asparaginase is critical in pediatric acute lymphoblastic leukemia (ALL) therapy but is highly immunogenic. Severe allergic reactions lead to substitution of further PEG\u2010asparaginase with <jats:italic>Erwinia<\/jats:italic>. <jats:italic>Erwinia<\/jats:italic> is associated with more frequent dosing, increased expense, and limited availability. Premedication may reduce rates of allergic reactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedures<\/jats:title><jats:p>This Markov model evaluated the cost\u2010effectiveness of three strategies: premedication plus therapeutic drug monitoring (TDM), TDM alone, and no premedication or TDM. We modeled two scenarios: a standard\u2010risk (SR) B\u2010ALL patient receiving two asparaginase doses and a high\u2010risk (HR) patient receiving seven asparaginase doses. The model incorporated costs of asparaginase, premedication, TDM and clinic visits, and lost parental wages associated with each additional <jats:italic>Erwinia<\/jats:italic> dose. We incorporated a five\u2010year time horizon with a societal perspective. Outcomes were <jats:italic>Erwinia<\/jats:italic> substitutions avoided and differences in quality\u2010adjusted life years (QALYs). Probabilistic and one\u2010way sensitivity analyses evaluated model uncertainty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In both scenarios, premedication was the least costly strategy. In SR and HR scenarios, premedication with monitoring resulted in 8% and 7% fewer changes to\u00a0Erwinia\u00a0compared with monitoring alone and 3% and 2% fewer changes compared with no premedication\/monitoring, respectively. Premedication resulted in the most QALYs gained in the SR patients. Individual variation of model inputs did not change premedication\/monitoring favorability for either scenario. In probabilistic sensitivity analyses, premedication\/monitoring was favored in &gt;87% of iterations in both scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared with other strategies, premedication use and asparaginase level monitoring in children with B\u2010ALL is potentially cost\u2010saving.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29051","type":"journal-article","created":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T00:04:23Z","timestamp":1618617863000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Premedication prior to PEG\u2010asparaginase is cost\u2010effective in pediatric patients with acute lymphoblastic leukemia"],"prefix":"10.1002","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-6369","authenticated-orcid":false,"given":"Meghan","family":"McCormick","sequence":"first","affiliation":[{"name":"University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian","family":"Lapinski","sequence":"additional","affiliation":[{"name":"C.S. Mott Children's Hospital, University of Michigan  Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Friehling","sequence":"additional","affiliation":[{"name":"University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Smith","sequence":"additional","affiliation":[{"name":"University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,16]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Oncaspar (pegaspargase) injection label"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2015.137380"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27065"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40272-015-0129-1"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2019.1608530"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-200404000-00002"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.03024"},{"key":"e_1_2_9_9_1","unstructured":"ERWINAZE (asparaginase Erwinia chrysanthemi) label.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2016\/125359s088lbl.pdf.Published March 2016. Accessed December 2 2020."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27797"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.19298.1"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16495"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1043454217741868"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","unstructured":"HenriksenLT Harila\u2010SaariA RuudE et\u00a0al.PEG\u2010asparaginase allergy in children with acute lymphoblastic leukemia in the NOPHO ALL2008 protocol.Pediatr Blood Cancer.2015;62(3):427\u2010433.https:\/\/doi.org\/10.1002\/pbc29051.25319","DOI":"10.1002\/pbc.25319"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-10-534347"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00363-0"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2017.1397658"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23380"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/08880018.2013.876134"},{"key":"e_1_2_9_20_1","unstructured":"NCI Bethesda MD"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-04-0222"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V99.6.1986"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2018.1542146"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V128.22.175.175"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000727"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880018.2018.1538277"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01086"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.4544"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20922"},{"issue":"9","key":"e_1_2_9_30_1","first-page":"1","article-title":"Deaths: final data for 2017","volume":"68","author":"Kochanek KD","year":"2019","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62002-8"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-02-265884"},{"key":"e_1_2_9_33_1","unstructured":""},{"key":"e_1_2_9_34_1","unstructured":"seer.cancer.gov\/archive\/csr\/1975_2010\/results_merged\/sect_28_childhood_cancer.pdf."},{"key":"e_1_2_9_35_1","unstructured":"2019"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djy193"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.79.0642"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.03.013"},{"key":"e_1_2_9_39_1","doi-asserted-by":"crossref","unstructured":"KloosRQH vanLitsenburgRRL WolfS et\u00a0al.A cost\u2010effectiveness analysis of Erwinia asparaginase therapy in children with acute lymphoblastic leukemia.Pediatr Blood Cancer.2019;66(1):e27458.https:\/\/doi.org\/10.1002\/pbc29051.27458","DOI":"10.1002\/pbc.27458"},{"key":"e_1_2_9_40_1","unstructured":"Employment and earnings table B\u20103b"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24096"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.5909"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20099"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880018.2019.1634778"},{"key":"e_1_2_9_45_1","unstructured":"Cancer in children and adolescents \u2013 National Cancer Institute"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2020-138840"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01692"},{"issue":"1","key":"e_1_2_9_48_1","first-page":"5574","article-title":"Use of premedication prior to asparaginase (ASNase) administration in pediatric acute lymphoblastic leukemia (ALL): effect on treatment completion rate","volume":"130","author":"Bernard C","year":"2017","journal-title":"Blood"},{"key":"e_1_2_9_49_1","doi-asserted-by":"crossref","unstructured":"HasanH ShaikhOM RassekhSR HowardAF GoddardK.Comparison of hypersensitivity rates to intravenous and intramuscular PEG\u2010asparaginase in children with acute lymphoblastic leukemia: a meta\u2010analysis and systematic review.Pediatr Blood Cancer.2017;64(1):81\u201088.https:\/\/doi.org\/10.1002\/pbc29051.26200","DOI":"10.1002\/pbc.26200"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2016.1218004"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.29051","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pbc.29051","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.29051","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T08:57:33Z","timestamp":1693213053000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.29051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,16]]},"references-count":49,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1002\/pbc.29051"],"URL":"https:\/\/doi.org\/10.1002\/pbc.29051","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,16]]},"assertion":[{"value":"2021-01-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e29051"}}