Descriptive Comparative Analysis of Acute Lymphoblastic Leukemia Treatment Standards

Abstract

Background: Acute lymphoblastic leukemia (ALL) remains the most common malignancy in childhood and requires a multi-phase, resource-dependent treatment strategy. Despite overall progress in pediatric hematology-oncology, considerable disparities persist between countries in access to advanced diagnostic methods, targeted therapies, and supportive care. These differences may influence treatment costs and survival outcomes. This study compares national pediatric ALL treatment standards in Uzbekistan, Russia, and Kazakhstan to evaluate diagnostic capabilities, chemotherapy protocols, drug availability, and economic efficiency. Materials and Methods: A descriptive comparative analysis was conducted using three national treatment protocols for pediatric ALL: Uzbekistan (Order No. 273, 2021), Russia (Protocol No. 1/ЗП/2020, 2020), and Kazakhstan (Protocol No. 187, 2023). Evaluation criteria included diagnostic procedures, functional examinations, specialist consultations, chemotherapy regimens, targeted therapy availability, and pharmacoeconomic indicators. The analysis also referenced widely applied international regimens (ALL-2009, Hyper-CVAD, and Helzer). Results: Diagnostic costs were lowest in Uzbekistan (US$195.90), followed by Kazakhstan (US$473.60) and Russia (US$753.78). All countries used multi-phase chemotherapy, while Kazakhstan included a broader range of targeted therapies. Total direct medical costs were US$279.68 in Uzbekistan, US$801.63 in Kazakhstan, and US$1,272.66 in Russia. Conclusion: Pediatric ALL protocols differed substantially in diagnostic scope, targeted therapy availability, and direct medical costs. Uzbekistan had the lowest overall costs, Kazakhstan included a broader range of targeted therapies with intermediate costs, and Russia had the highest costs. Further clinical and pharmacoeconomic studies are needed to assess the cost-effectiveness of these approaches.