title: Health economic impact of high-dose versus standard-dose cytarabine induction chemotherapy for acute myeloid leukaemia.
abstract: BACKGROUND
  Induction chemotherapy for acute myeloid leukaemia (AML) is one of the most resource-intensive cancer therapies delivered in hospitals.
  
  
  OBJECTIVE
  To assess the health resource impact of different chemotherapy approaches for AML commonly used in Australia.
  
  
  METHODS
  A retrospective analysis was undertaken in 63 patients aged 18-55 years with AML given induction with either 7 + 3 (cytarabine 100 mg/m(2) days 1-7 and idarubicin 12 mg/m(2) days 1-3) or HiDAC-3 (high-dose cytarabine 3 g/m(2) twice daily days 1, 3, 5 and 7 and idarubicin 12 mg/m(2) 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(2) twice daily days 1, 3, 5 and 7) × either three or four cycles (following 7 + 3) and IcE (idarubicin 12,mg/m(2) days 1-2, cytarabine 100 mg/m(2) × 5 days and etoposide 75 mg/m(2) × 5 days) × 2 cycles (following HiDAC-3) were modelled, using a policy of discharge following completion of chemotherapy with outpatient monitoring.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Regimens minimising the total number of chemotherapy cycles may represent the most efficient use of limited health resources for the treatment of AML.
authors.affiliation: Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: P L
authors.initials: PL
authors.lastname: Fedele
authors.forename: S
authors.initials: S
authors.lastname: Avery
authors.forename: S
authors.initials: S
authors.lastname: Patil
authors.forename: A
authors.initials: A
authors.lastname: Spencer
authors.forename: M
authors.initials: M
authors.lastname: Haas
authors.forename: A
authors.initials: A
authors.lastname: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000191:economics; D003561:Cytarabine / Q000008:administration & dosage* / Q000191:economics; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics*; D006801:Humans; D060828:Induction Chemotherapy / Q000191:economics*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D014739:Victoria; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine
keywords: HiDAC; acute myeloid leukaemia; cost effectiveness; cytarabine