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


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.


CONCLUSIONS
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.
Yu
Y-B
YB
Division of Hematology and Oncology, Department of Medicine, Taipei-Veterans General Hospital, Taiwan 11217, Republic of China.
Gau
J-P
JP
You
J-Y
JY
Chern
H-H
HH
Chau
W-K
WK
Tzeng
C-H
CH
Ho
C-H
CH
Hsu
H-C
HC
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001087:Arabinonucleosides / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000601:surgery; D033581:Stem Cell Transplantation / Q000191:economics*; D013624:Taiwan; D013997:Time Factors; D014182:Transplantation, Autologous / Q000191:economics; D014184:Transplantation, Homologous / Q000191:economics; D016896:Treatment Outcome
D001087:Arabinonucleosides