What Is the CADTH Reimbursement Recommendation for Atriance?: CADTH recommends that Atriance should be reimbursed by public drug plans for the treatment of pediatric, adolescent, and young adult patients with intermediate- or high-risk T-cell acute lymphoblastic leukemia (T-ALL) in addition to front-line multiagent chemotherapy if certain conditions are met.
Which Patients Are Eligible for Coverage?: Atriance (nelarabine) should only be covered to treat patients with intermediate- and high-risk T-ALL who are aged 1 year to 30 years.
What Are the Conditions for Reimbursement?: Atriance should only be reimbursed as an addition to front-line multiagent chemotherapy. Atriance should be prescribed by clinicians with expertise and experience in treating T-ALL.
Why Did CADTH Make This Recommendation?:
Evidence from a phase III clinical trial showed that treatment with Atriance, compared with chemotherapy alone, delays disease recurrence and allows patients to live longer.
Atriance meets patients’ needs because it improves the length of time patients are disease-free, has manageable side effects, and may reduce the need for cranial radiation and transplantation.
Based on CADTH’s assessment of the health economic evidence, Atriance may represent a good value to the health care system for pediatric, adolescent, and young adult (aged 1 year to 30 years) patients with intermediate- and high-risk T-ALL, at the public listed prices for Atriance and comparators.
Based on public list prices, Atriance is estimated to cost the public drug plans approximately $6.6 million over the next 3 years.
What Is T-ALL?: Acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). T-ALL is a type of ALL that affects T lymphocytes. T-ALL is an aggressive cancer that progresses quickly. Symptoms of T-ALL are nonspecific and may include fatigue, pain, bleeding, enlarged lymph nodes, and other symptoms. T-ALL is more common in children than in adults. T-ALL can be classified as high risk, intermediate, or low risk, which refers to the chance of a good response using standard treatment.
Unmet Needs in T-ALL: Patients with T-ALL have a poor prognosis, and cancer may come back or worsen for some patients who are at high risk for disease recurrence. Patients with relapsed T-ALL require total body irradiation (to kill any cancer cells that are left in the body and help make room in the bone marrow for new blood stem cells to grow) and stem cell transplant (healthy stem cells are transplanted into patient’s bone marrow or blood), which exposes patients to a significant risk of morbidity (e.g., infection, secondary cancerous tumours caused by treatment with radiation or chemotherapy, reduced quality of life). Therefore, successful front-line treatment in patients with newly diagnosed T-ALL is important to minimize the recurrence rate, prolong life, and improve health-related quality of life.
How Much Does Atriance Cost?: Treatment with Atriance is expected to cost approximately $34,772 per patient per course in addition to front-line multiagent chemotherapy.