Cost-effectiveness of postremission intensive therapy in patients with acute leukemia

• Published in: Annals of oncology Vol. 18; no. 3; pp. 529 - 534
• Main Authors: Yu, Y-B, Gau, J-P, You, J-Y, Chern, H-H, Chau, W-K, Tzeng, C-H, Ho, C-H, Hsu, H-C
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-03-2007; Oxford Publishing Limited (England)
• Subjects: acute myelogenous leukemia; Adult; Aged; allogeneic stem-cell transplantation; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Arabinonucleosides - administration & dosage; Biological and medical sciences; Cost-Benefit Analysis; cost-effectiveness; Drug Costs; Female; Follow-Up Studies; Health Care Costs; Hematologic and hematopoietic diseases; high-dose arabinoside; Humans; Kaplan-Meier Estimate; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - economics; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - surgery; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; postremission therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - economics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery; Stem Cell Transplantation - economics; Taiwan; Time Factors; Transplantation, Autologous - economics; Transplantation, Homologous - economics; Treatment Outcome; Taiwan; Human; cost-effectiveness; Stem cell; Hematopoietic cell; Homograft; Acute leukemia; acute myelogenous leukemia; Malignant hemopathy; allogeneic stem-cell transplantation; Consolidation treatment; Health economy; Graft; High dose; high-dose arabinoside; postremission therapy; Cost efficiency analysis; Acute myelocytic leukemia
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdl420

Background: We assessed the cost-effectiveness of high-dose arabinoside (HiDAC)-based and allogeneic stem-cell transplantation (alloSCT)-based therapy in patients with acute leukemia. Patients and methods: We analyzed the outcome, cost and cost-effectiveness of 106 patients treated from January 1994 to January 2002 [94 acute myelogenous leukemia (AML)/12 acute lymphoblastic leukemia (ALL)]. Forty-two young patients at either intermediate or unknown cytogenetic risk received postremission intensive therapy (24 HiDAC-based/18 alloSCT-based therapy). Results: After a median follow-up of 50 months, the estimated 7-year overall survival for the HiDAC-based group showed a tendency to be higher than the alloSCT-based group (48% versus 28%, P = 0.1452). The HiDAC-based group spent a significantly lower total cost ($US51 857 versus 75 474, P = 0.004) than the alloSCT-based group. Cost-effectiveness analysis showed that the mean cost per year of life saved for the HiDAC-based group is considerably less expensive than the alloSCT-based group ($US11 224 versus 21 564). The reduced total cost for the HiDAC-based group originated from lower cost in room fees, medication, laboratory and procedure, but not in blood transfusion and professional manpower fees. Conclusion: For the postremission therapy in young AML patients at either intermediate or unknown cytogenetic risk, cost-effectiveness of HiDAC-based therapy compares favorably with that of alloSCT-based therapy, which deserves further clinical trials.