Health economic impact of high‐dose versus standard‐dose cytarabine induction chemotherapy for acute myeloid leukaemia. Issue 8 (August 2014)

• Record Type: Journal Article
• Authors: Fedele, P. L.; Avery, S.; Patil, S.; Spencer, A.; Haas, M.; Wei, A.
• Is Part Of: Internal medicine journal. Volume 44:Issue 8(2014)
• Page Start: 757
• Page End: 763
• Publication Date: 2014-08
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12478
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12478-sec-9001" sec-type="section"> <title>Background</title> <p>Induction chemotherapy for acute myeloid leukaemia (AML) is one of the most resource‐intensive cancer therapies delivered in hospitals.</p> </sec> <sec id="imj12478-sec-0001" sec-type="section"> <title>Aims</title> <p>To assess the health resource impact of different chemotherapy approaches for AML commonly used in Australia.</p> </sec> <sec id="imj12478-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective analysis was undertaken in 63 patients aged 18–55 years with AML given induction with either 7 + 3 (cytarabine 100 mg/m<sup>2</sup> days 1–7 and idarubicin 12 mg/m<sup>2</sup> days 1–3) or HiDAC‐3 (high‐dose cytarabine 3 g/m<sup>2</sup> twice daily days 1, 3, 5 and 7 and idarubicin 12 mg/m<sup>2</sup> days 1–3) chemotherapy. Average costs of hospitalisation, pathology, radiology, chemotherapy and ancillary drugs were calculated and compared with current Victorian casemix funding. Two consolidation approaches, HiDAC (cytarabine 3 g/m<sup>2</sup> twice daily days 1, 3, 5 and 7) × either three or four cycles (following 7 + 3) and IcE (idarubicin 12 mg/m<sup>2</sup> days 1–2, cytarabine 100 mg/m<sup>2</sup> × 5 days and etoposide 75 mg/m<sup>2</sup> × 5 days) × 2 cycles (following HiDAC‐3) were modelled, using a policy of discharge following completion of chemotherapy with outpatient monitoring.</p> </sec> <sec id="imj12478-sec-0003" sec-type="section"> <title>Results</title> <p>The cost (in AUD) of induction was similar between 7 + 3 ($58 037) and HiDAC‐3 ($56 902), with bed day costs accounting for 61–62% of the total expense. Blood bank costs ranked second, accounting for 15%. Accumulated costs for HiDAC consolidation were $44 289 for a three‐cycle protocol and $59 052 for four cycles ($14 763 per cycle) versus $31 456 for two cycles of IcE consolidation ($15 728 per cycle). Overall, the classical 7 + 3 → HiDAC approach ($102 326/$117 089 for three or four consolidation cycles) incurs a greater cost than a HiDAC‐3 → IcE × 2 approach ($88 358). For patients requiring complete hospitalisation until neutrophil recovery, the estimated costs of treatment will be even higher, ranging between $122 282 for HiDAC‐3 → IcE × 2, $153 212 for 7 + 3 → HiDAC × 3 and $184 937 for 7 + 3 → HiDAC × 4. State‐based casemix funding for non‐complicated AML therapy is currently $74 013 for 7 + 3 → HiDAC × 4, $64 177 for 7 + 3 → HiDAC × 3 and $54 340 for HiDAC‐3 → IcE × 2 based on outpatient recovery after consolidation chemotherapy. These calculations do not take into account additional resource implications associated with complications of consolidation chemotherapy or reinduction for treatment failure.</p> </sec> <sec id="imj12478-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Regimens minimising the total number of chemotherapy cycles may represent the most efficient use of limited health resources for the treatment of AML.</p> </sec> </abstract>