Medical costs of treatment and survival of patients with acute myeloid leukemia in Belgium.
The advent of new cell-based immunotherapies for leukemia offers treatment possibilities for certain leukemia subgroups. The wider acceptability of these new technologies in clinical practice will depend on its impact on survival and costs. Due to the small patient groups who have received it, these aspects have remained understudied. This non-randomized single-center study evaluated medical costs and survival for acute myeloid leukemia between 2005 and 2010 in 50 patients: patients treated with induction and consolidation chemotherapy (ICT) alone; patients treated with ICT plus allogeneic hematopoietic stem cell transplantation (HCT), which is the current preferred post-remission therapy in patients with intermediate- and poor-risk AML with few co-morbidities, and patients treated with ICT plus immunotherapy using autologous dendritic cells (DC) engineered to express the Wilms' tumor protein (WT1). Total costs including post- consolidation costs on medical care at the hematology ward and outpatient clinic, pharmaceutical prescriptions, intensive care ward, laboratory tests and medical imaging were analyzed. Survival was markedly better in HCT and DC. HCT and DC were more costly than ICT. The median total costs for HCT and DC were similar. These results need to be confirmed to enable more thorough cost-effectiveness analyses, based on observations from multicenter, randomized clinical trials and preferably using quality-adjusted life-years as an outcome measure.
Division of Hematology, Antwerp University Hospital, Edegem, Belgium. Electronic address: ann.van.de.velde@uza.be.
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Van de Velde
Centre for Health Economics Research & Modeling Infectious Diseases, University of Antwerp, Antwerp, Belgium.
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Beutels
Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital, Edegem, Belgium; Center for Oncological Research, University of Antwerp, Antwerp, Belgium.
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Smits
Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital, Edegem, Belgium.
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Van Tendeloo
Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital, Edegem, Belgium.
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Nijs
Division of Hematology, Antwerp University Hospital, Edegem, Belgium.
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Anguille
Division of Hematology, Antwerp University Hospital, Edegem, Belgium.
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Verlinden
Division of Hematology, Antwerp University Hospital, Edegem, Belgium.
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Gadisseur
Division of Hematology, Antwerp University Hospital, Edegem, Belgium.
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Schroyens
Business Intelligence, Antwerp University Hospital, Edegem, Belgium.
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Dom
Business Intelligence, Antwerp University Hospital, Edegem, Belgium.
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Cornille
Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Belgium.
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Goossens
Division of Hematology, Antwerp University Hospital, Edegem, Belgium; Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital, Edegem, Belgium.
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Berneman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D060830:Consolidation Chemotherapy / Q000191:economics; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000379:methods; D006801:Humans; D007167:Immunotherapy / Q000191:economics; D060828:Induction Chemotherapy / Q000191:economics; D015470:Leukemia, Myeloid, Acute / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D015996:Survival Rate; D014184:Transplantation, Homologous; D055815:Young Adult
Acute myeloid leukemia; Costs; Dendritic cell vaccination; Hematopoietic stem cell transplantation; Post-consolidation treatment; Wilm’s tumor protein