Applied Health Economics and Health Policy

, Volume 10, Issue 6, pp 431–440 | Cite as

Economic Implications of Rasburicase Treatment in Adult Patients with Tumour Lysis Syndrome

  • Michael Eaddy
  • Brian Seal
  • Krishna Tangirala
  • Elizabeth Hackney Davies
  • Ken O’Day
Original Research Article


Background: 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.

Methods: 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 g-distributed generalized linear models with a log-link function.

Results: 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).

Conclusion: 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.


Uric Acid Propensity Score Allopurinol Tumour Lysis Syndrome Sevelamer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank Nicholas J. Sarlis, MD, PhD, Senior Medical Director, sanofi-aventis US for several discussions over the entire duration of this analysis, as well as for his helpful comments on this manuscript.

Disclosures: This study was supported by sanofi-aventis US. The authors were fully responsible for all content, editorial decisions and opinions expressed in the article.

Dr Eaddy and Dr O’Day are employed by Xcenda and are consultants for sanofi-aventis US, which manufactures the Elitek brand of rasburicase and supported this study. At the time of this research, Ms Davies was an employee of Xcenda. Dr Seal was employed by sanofi-aventis US at the time of the study and owns sanofi-aventis stock. Mr Tangirala is employed by sanofi-aventis.

Author contributions: All authors contributed to the study design, interpretation and writing of the manuscript. The analysis was completed by Mr Tangirala, who is also the guarantor of this manuscript.


  1. 1.
    Gemici C. Tumour lysis syndrome in solid tumours. Clin Oncol (R Coll Radiol) 2006; 18: 773–80CrossRefGoogle Scholar
  2. 2.
    Jones DP, Mahmoud H, Chesney RW. Tumor lysis syndrome: pathogenesis and management. Pediatr Nephrol 1995; 9: 206–12PubMedCrossRefGoogle Scholar
  3. 3.
    Bosley A, Snoet A, Pinkerton CR, et al. Rasburicase (recombinant urate oxidase) for the management of hyperuricemia in patients with cancer. Cancer 2003; 98(5): 1048–54CrossRefGoogle Scholar
  4. 4.
    Pui C, Hazem HH, Wiley JM, et al. Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma. J Clin Oncol 2001; 19(3): 697–704PubMedGoogle Scholar
  5. 5.
    Pui C, Jeha S, Irwin D, et al. Recombinant urate oxidase in the prevention and treatment of malignancy-associated hyperuricemia in pediatric and adult patients: results of a compassionate-use trial. Leukemia 2001; 15: 1505–9PubMedCrossRefGoogle Scholar
  6. 6.
    Navolonic PM, Pui C, Larson RA, et al. Elitek™— rasburicase: an effective means to prevent and treat hyperuricemia associated with tumor lysis syndrome, a meeting report, Dallas, Texas, January 2002. Leukemia 2003; 17: 499–514CrossRefGoogle Scholar
  7. 7.
    Mughal TI, Ejaz AA, Foringer JR, et al. An integrated clinical approach for the identification, prevention, and treatment of tumor lysis syndrome. Cancer Treat Rev 2010 Apr; 36(2): 164–76PubMedCrossRefGoogle Scholar
  8. 8.
    Band PR, Silverberg DS, Henderson JF, et al. Xanthine nephropathy in a patient with lymphosarcoma treated with allopurinol. N Engl J Med 1970; 283: 354–7PubMedCrossRefGoogle Scholar
  9. 9.
    Andreoli SP, Clark JH, McGuire WA, et al. Purine excretion during tumor lysis in children with acute lymphocytic leukemia receiving allopurinol: relationship to acute renal failure. J Pediatr 1986; 109: 292–8PubMedCrossRefGoogle Scholar
  10. 10.
    Monballyu J, Zachee P, Verberckmoes R, et al. Transient acute renal failure due to tumor-lysis-induced severe phosphate load in a patient with Burkitt’s lymphoma. Clin Nephrol 1984; 22: 47–50PubMedGoogle Scholar
  11. 11.
    Brogard JM, Coumaros D, Franckhauser J, et al. Enzymatic uricolysis: a study of the effect of a fungal urate-oxydase. Rev Eur Etudes Clin Biol 1972; 17: 890–5Google Scholar
  12. 12.
    Jeha S, Kantarjian H, Irwin D, et al. Efficacy and safety of rasburicase, a recombinant urate oxidase (Elitek™), in the management of malignancy-associated hyperuricemia in pediatric and adult patients: final results of a multicenter compassionate use trial. Leukemia 2005; 19: 34–8PubMedGoogle Scholar
  13. 13.
    Coiffier B, Mounier N, Bologna S, et al. Efficacy and safety of rasburicase (recombinant urate oxidase) for the prevention and treatment of hyperuricemia during induction chemotherapy of aggressive non-Hodgkin’s lymphoma: results of the GRAAL1 (Groupe d’Etude des Lymphomes de l’Adulte Trial on Rasburicase Activity in Adult Lymphoma) study. J Clin Oncol 2003; 21: 4402–6PubMedCrossRefGoogle Scholar
  14. 14.
    Patte C, Sakiroglu C, Ansoborlo A, et al. Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia, treated in the Société Française d’Oncologie Pédiatrique LMB89 protocol. Ann Oncol 2002; 13: 789–95PubMedCrossRefGoogle Scholar
  15. 15.
    Candrilli S, Bell T, Irish W, et al. A comparison of inpatient length of stay and costs among patients with hematologic malignancies (excluding Hodgkin disease) associated with and without renal failure. Clin Lymphoma Myeloma 2008; 8(1): 44–51PubMedCrossRefGoogle Scholar
  16. 16.
    Eaddy M, Seal B, Tangirala M, et al. Economic comparison of rasburicase and allopurinol for treatment of tumor lysis syndrome in pediatric patients. Am J Health Syst Pharm 2010 Dec; 67(24): 2110–4PubMedCrossRefGoogle Scholar
  17. 17.
    ELITEK® [package insert]. Bridgewater (NJ): sanofi-aventis, June 2008Google Scholar
  18. 18.
    Solh M, Appel J. Tumor lysis syndrome. Hosp Physician 2008; 44(9): 25–9Google Scholar
  19. 19.
    RedBook Online®, Thomson Reuters (Healthcare) Inc. Available from URL: [Accessed 2012 Jul 23]
  20. 20.
    Trifilio S, Gordon L, Singhal S, et al. Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia. Bone Marrow Transplant 2006; 37: 997–1001PubMedCrossRefGoogle Scholar
  21. 21.
    Wang L, Shih L, Chang H, et al. Recombinant urate oxidase (rasburicase) for the prevention and treatment of tumor lysis syndrome in patients with hematologic malignancies. Acta Haematol 2006; 115: 35–8PubMedCrossRefGoogle Scholar
  22. 22.
    Campara M, Shord SS, Haaf CM. Single-dose rasburicase for tumour lysis syndrome in adults: weight-based approach. J Clin Pharm Ther 2009; 34: 207–13PubMedCrossRefGoogle Scholar
  23. 23.
    Hummel M, Buchheidt D, Reiter S, et al. Recurrent chemotherapy-induced tumor lysis syndrome (TLS) with renal failure in a patient with chronic lymphocytic leukemia: successful treatment and prevention of TLS with low-dose rasburicase. Eur J Haematol 2005; 75: 518–21PubMedCrossRefGoogle Scholar
  24. 24.
    Hutcherson DA, Gammon DC, Bhatt MS, et al. Reduceddose rasburicase in the treatment of adults with hyperuricemia associated with malignancy. Pharmacotherapy 2006; 26: 242–7PubMedCrossRefGoogle Scholar
  25. 25.
    Liu CY, Sims-McCallum RP, Schiffer C. A single dose of rasburicase is sufficient for the treatment of hyperuricemia in patients receiving chemotherapy. Leukemia Res 2005; 29: 463–5CrossRefGoogle Scholar
  26. 26.
    McDonnell AM, Lenz KL, Frei-Lahr DA, et al. Single-dose rasburicase 6 mg in the management of tumor lysis syndrome in adults. Pharmacotherapy 2006; 26: 806–12PubMedCrossRefGoogle Scholar
  27. 27.
    Arnold TM, Reuter JP, Delman BS, et al. Use of single-dose rasburicase in an obese female. Ann Pharmacother 2004; 38: 1428–31PubMedCrossRefGoogle Scholar
  28. 28.
    Annemans L, Moeremans K, Lamotte M, et al. Pan-European mul ticentre economic evaluation of recombinant urate oxidase (rasburicase) in prevention and treatment of hyperuricaemia and tumour lysis syndrome in haematological cancer patients. Support Care Cancer 2003; 11: 249–57PubMedGoogle Scholar
  29. 29.
    Xcenda. Elitek hospital model. Developed October 2009. On file with sanofi-aventisGoogle Scholar

Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Michael Eaddy
    • 1
  • Brian Seal
    • 2
  • Krishna Tangirala
    • 3
  • Elizabeth Hackney Davies
    • 1
  • Ken O’Day
    • 1
  1. 1.Xcenda, LLCPalm HarborUSA
  2. 2.Bayer HealthcareWayneUSA
  3. USBridgewaterUSA

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