Cost-Effectiveness of Limited Screening Panel for Acute Lymphoblastic Leukemia Diagnosis in a Resource-Limited Setting

Keywords: limited screening panel, acute lymphoblastic leukemia, pediatric population, Filipino

Abstract

Background: Flow cytometry is an invaluable tool in the diagnostic evaluation of acute leukemia and post therapy monitoring; however, majority of Filipino population cannot afford the cost. The use of a minimal screening panel which is both cost-effective and provides an accurate diagnosis of acute lymphoblastic leukemia is seen as an alternative.

Objectives: We aim to determine the cost-effectiveness and accuracy of using a minimal screening panel for the diagnosis of acute lymphoblastic leukemia (ALL).

Methodology: We selected a limited panel of 9 antibodies comprising of CD45/CD19/CD20/CD10/HLA-DR/CD34/cCD3/cCD79a/cTdt and retrospectively reviewed newly diagnosed cases of B-cell and T-cell ALL from September 2016 to December 2019 using this panel.

Results: Out of 719 bone marrow aspirates submitted for basic leukemia flow cytometric analysis we identified 268 ALL cases (239 B-ALL and 29 T-ALL).

In all cases, a diagnosis was established using the limited panel. Compared to the current cost of our comprehensive panel (₱ 9,903.60). This limited panel cost ₱ 3,062.29, that offers a 69.08% savings per test, which translated to a ₱1.2 million savings a year (for an average of 180 annual cases).

Conclusion: We underscore the utility of a limited panel for the diagnosis of ALL. Although this panel remains to be assessed with a larger validation cohort, its application in resource-limited developing countries is diagnostically useful and cost-effective.

Recommendation: The use of a limited panel of 9 antibodies is recommended as a screening panel for patients who are highly suspected of having ALL both clinically and initial bone marrow smear assessment.

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Author Biographies

Ivy Mae Medalla, Philippine Children’s Medical Center

Medical Officer II, Division of Pathology

Maria Beatriz Gepte, Philippine Children’s Medical Center

Clinical Oncology Unit Head, Cancer and Hematology Center

Qareem Pido, Philippine Children’s Medical Center

Visiting Consultant, Division of Pathology

Daphne Ang, Philippine Children’s Medical Center

Medical Specialist III, Division of Pathology

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Published
2021-06-29
How to Cite
Medalla, I. M., Gepte, M. B., Pido, Q., & Ang, D. (2021). Cost-Effectiveness of Limited Screening Panel for Acute Lymphoblastic Leukemia Diagnosis in a Resource-Limited Setting. PJP, 6(1), 27-30. https://doi.org/10.21141/PJP.2021.04
Section
Original Articles