ANTI-TUMOUR TREATMENT
Economic burden of acute myeloid leukemia: a literature review

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Abstract

Objective: The primary objective was to examine the economic burden associated with acute myeloid leukemia (AML), a deadly hematological malignancy. AML is the most common form of acute leukemia in adults, particularly in individuals over 60 years of age; AML also accounts for 15–20% of childhood leukemia.

Materials and methods: A systematic review was conducted of relevant studies published in the English language. Economic analyses of AML published between 1990 and 2002 were identified from electronic data sources using broad search criteria. Additional studies were obtained by manual searches of bibliographies of articles identified in the electronic searches. Articles were screened for relevance and included if the main theme included some element of AML cost of treatment, cost drivers, or cost-effectiveness. Studies reporting only drug prices without a formal comparison or analysis were not included.

Results: Twenty-nine studies were included in the review. Although information was limited on the comprehensive economic burden of AML from a societal perspective, the costs appear to be split equally between direct and indirect costs. Direct costs of AML from a public payer perspective were available for a few countries such as the Netherlands, Sweden, US (Medicare), and Italy. These studies found that the key cost drivers appear to be hospitalization length of stay related to initial chemotherapy, relapse of disease, and bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT). Several cost analyses have been published comparing the different treatment strategies; however, most of them were published in the early 1990s, and their analysis revolved around cost-comparison rather than comprehensive cost-effectiveness. The published studies investigated pharmacological agents (e.g., idarubicin, daunorubicin, mitoxantrone, fludarabine and combination therapies), as well as BMT, PBSCT, and the treatment of complications.

Conclusion: Studies addressing the economic costs and burden of AML are relatively sparse in the international literature. Possible reasons for such a lack of information appear to include the low incidence rate of AML (e.g., about 260,000 new cases were reported in 2002 in the world) and the fact that it primarily afflicts older adults >60 years of age, making broad, well-designed economic analyses a challenge for most researchers. However, due to the high cost associated with the medical procedures (e.g., BMT, PBSCT) and the aging of the world population, further research is warranted.

Section snippets

Introduction and objective

Acute myeloid leukemia (AML) is the most common form of leukemia in adults and accounts for approximately 15–20% of childhood leukemia. The annual incidence rate is low compared to other cancer diseases (approximately 260,000 new cases in the world in 2002). The average incidence of AML typically ranges between one and three cases per 100,000 individuals, except in the United States and Australia, where it ranges from two to six cases per 100,000. The median age of diagnosis is 65 years, and

Methods

We conducted a systematic literature review focused on AML's economic burden. Specifically, we researched the overall cost imposed on society, direct costs by treatment stage, and costs or cost-effectiveness of different treatment strategies. Although the initial search was limited to English language articles published between 1990 and 2002, inclusion of a few additional articles published before 1990 was judged necessary for the sake of completeness. Much effort was expended to ensure that

Overall economic burden of AML

Due to the nature of the disease (with initial treatments, remissions, and relapses), the total economic burden of AML is difficult to establish. Only one study, conducted in Sweden in 1992 by Tenvall et al.,1 reported the direct and indirect national/societal estimates of the economic burden of AML. Using modeling techniques on the basis of information from 275 patients diagnosed in 1989, Tenvall estimated the total costs of AML in Sweden in 1992 at SEK461 million annually. This total cost was

Chemotherapy

Several cost analyses published between 1990 and 1992 reported idarubicin to be more cost-effective than daunorubicin as a chemotherapy agent for induction therapy. Pashko et al.11 reported the cost-effectiveness of idarubicin and daunorubicin in the US His comparison primarily relied on superior clinical effectiveness data of idarubicin. For instance, the proportion of patients treated with idarubicin who achieved complete remission was 80%, while the number was 58% for patients treated with

Discussion and conclusions

Very limited recent data has been found in the international literature describing the total economic burden of AML. The limited number of new diagnoses annually with this deadly malignancy compared to other types of cancer, and the fact that it is considered mainly a disease of the elderly (e.g., 65+ years), may have contributed to the scarce attention devoted to the economic impact of AML. The direct costs of AML with details by patient and/or disease stage have been more broadly studied. On

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