The outcomes and costs of acute myeloid leukemia among the elderly.
BACKGROUND
The incidence of acute myeloid leukemia (AML) among the elderly can be expected to grow as the population continues to age. However, data on current treatment practices and costs for this form of cancer are sparse.


METHODS
We used a retrospective inception cohort design and data from a linkage between 11 Surveillance, Epidemiology, and End Results cancer registries and Medicare administrative claims. We evaluated survival, use of health care resources, use of chemotherapy, and Medicare payments among adults 65 years and older with an initial diagnosis of AML between January 1, 1991, and December 31, 1996.


RESULTS
A total of 2657 elderly patients with AML and complete Medicare claims data were identified. The prognosis for these patients was poor, with median survival estimated to be 2 months and a 2-year survival rate of 6%. Mean +/- SE total Medicare payments were $41,594 +/- $870 (in 1998 US dollars), 84% of which was attributed to inpatient payments. In the 2 years after the AML diagnosis, 790 patients (30%) underwent chemotherapy treatment. These patients had costs almost 3 times higher than those of other patients, and their median survival was 6 months longer. The use of hospice care was rare (17% of patients).


CONCLUSIONS
Among the elderly, AML is associated with a poor prognosis and substantial costs during the relatively few remaining months of life. Moreover, most patients do not receive active treatment with chemotherapy or hospice services. Further work is needed to characterize this disease and the patient-related factors that influence treatment decisions and associated health outcomes.
Menzin
Joseph
J
Boston Health Economics, Inc, 20 Fox Rd, Waltham, MA 02451, USA. jmenzin@bhei.com
Lang
Kathleen
K
Earle
Craig C
CC
Kerney
Donna
D
Mallick
Rajiv
R
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000191:economics; D004358:Drug Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007951:Leukemia, Myeloid / Q000175:diagnosis / Q000191:economics* / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology