title: Reduced medical costs and hospital days when using oral arsenic plus ATRA as the first-line treatment of acute promyelocytic leukemia.
abstract: We have demonstrated that oral arsenic (Realgar-Indigo naturalis formula, RIF) plus all-trans retinoic acid (ATRA) is not inferior to intravenous arsenic trioxide (ATO) plus ATRA as the first-line treatment of acute promyelocytic leukemia (APL). To compare the cost-effectiveness of oral and intravenous arsenic, we analyzed the results of 30 patients in each group involved in a randomized controlled trial at our center. The median total medical costs were $13,183.49 in the RIF group compared with $24136.98 in the ATO group (p<0.0001). This difference primarily resulted from the different costs of induction therapy (p=0.016) and maintenance treatment (p<0.0001). The length of hospitalization for the RIF group was significantly lower than that for the ATO group (24 vs. 31 days, p<0.0001) during induction therapy. During maintenance treatment, the estimated medical costs were $2047.14 for each patient in the RIF group treated at home compared with $11273.81 for each patient in the ATO group treated in an outpatient setting (p<0.0001). We conclude that oral RIF plus ATRA significantly reduced the medical costs and length of hospital stay during induction and remission therapy compared with ATO plus ATRA in APL patients.
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing 100191, China.
authors.forename: Gong-Wen
authors.initials: GW
authors.lastname: Liang
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing 100191, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing 100191, China. Electronic address: shilu@bjmu.edu.cn.
authors.forename: Lu-Wen
authors.initials: LW
authors.lastname: Shi
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China. Electronic address: zhuhhdoc@163.com.
authors.forename: Hong-Hu
authors.initials: HH
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage / Q000191:economics; D002681:China; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005260:Female; D017048:Health Care Costs; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000191:economics; D060046:Maintenance Chemotherapy / Q000191:economics; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D012189:Retrospective Studies; D014212:Tretinoin / Q000008:administration & dosage / Q000191:economics; D055815:Young Adult
chemical_list: D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide
keywords: Acute promyelocytic leukemia; Arsenic; Medical costs; Retinoic acid