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Annals of Oncology Advance Access originally published online on December 12, 2006
Annals of Oncology 2007 18(3):529-534; doi:10.1093/annonc/mdl420
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© 2006 European Society for Medical Oncology

hematologic malignancies

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

Y-B Yu1,2, J-P Gau1,2, J-Y You1,2, H-H Chern3, W-K Chau1,2, C-H Tzeng2,4, C-H Ho1,2 and H-C Hsu1,2,5,*

1 Division of Hematology and Oncology, Department of Medicine, Taipei-Veterans General Hospital
2 Department of Medicine, School of Medicine, National Yang-Ming University
3 Information Service Center, Taipei-Veterans General Hospital
4 Division of Transfusion Medicine, Department of Medicine, Taipei-Veterans General Hospital
5 Institute of Physiology, School of Medicine, National Yang-Ming University; Taipei, Taiwan, Republic of China

* Correspondence to: Dr H.-C. Hsu, Division of Hematology and Oncology, Department of Medicine, Taipei-Veterans General Hospital, Shih-Pai Road, Taipei, Taiwan 11217, Republic of China. Tel: +886-2-2871-2121 ext. 3865; Fax: +886-2-6610-9119; E-mail: hchsu{at}vghtpe.gov.tw

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.

Patients and 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.

Conclusion: 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.

Key words: acute myelogenous leukemia, allogeneic stem-cell transplantation, cost-effectiveness, high-dose arabinoside, postremission therapy

Received for publication July 10, 2006. Revision received September 16, 2006. Accepted for publication October 12, 2006.


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