Objectives: To investigate the budgetary impact from the introduction of pegaspargase as a treatment for pediatric, adolescents and adult patients with acute lymphoblastic leukemia (ALL) in Greece.

Methods: A budget impact model was adapted from a public payer perspective, to delineate the financial implications of pegaspargase inclusion in the currently marketed treatment combination of ALL, over the next 5 years (2021–2025). The model framework considered market share scenarios with and without pegaspargase as first line treatment, switch to Erwinase as second line treatment in case of hypersensitivity, and direct reimbursement costs of treatment applied to the eligible Greek patient’s population. Pharma’s projection estimates were used for building up the market shares of the analyses. Costs related to drug acquisition were considered and unit costs were retrieved from Greek official sources (V, 2020). Safety and epidemiological data were retrieved from both officially published sources and clinical experts. The measured outcomes were incremental cost and total budget impact, calculated by comparing the respective budget expenditures with and without pegaspargase in the market share mix scenarios.

Results: The analysis showed that adding pegaspargase treatment sequence to ALL Greek market share mix, resulted in considerable cost-savings compared to L-asparaginase treatment sequence with a budget impact of - V1,644,357 (-19%) over a five-year time horizon. Through the years, the gradual increasing of market share of pegaspargase treatment sequence in each calendar year was associated with the gradual increasing of cost-savings for public payer, ending up with the highest total cost-savings of - V462,856 (-26%) in the last year of analysis (2025).

Conclusions: This budget impact analysis suggests that, the inclusion of pegaspargase for ALL treatment was predicted to be associated with short and long-term cost-savings for payers in Greece.