Health economic impact of high-dose versus standard-dose cytarabine induction chemotherapy for acute myeloid leukaemia

Induction chemotherapy for acute myeloid leukaemia (AML) is one of the most resource-intensive cancer therapies delivered in hospitals. Aims: 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 100mg/m2 days 1-7 and idarubicin 12mg/m2 days 1-3) or HiDAC-3 (high-dose cytarabine 3g/m2 twice daily days 1, 3, 5 and 7 and idarubicin 12mg/m2 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 3g/m2 twice daily days 1, 3, 5 and 7) ? either three or four cycles (following 7 + 3) and IcE (idarubicin 12mg/m2 days 1-2, cytarabine 100mg/m2 ? 5days and etoposide 75mg/m2 ? 5days) ? 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 ( 58037) and HiDAC-3 ( 56902), 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 44289 for a three-cycle protocol and 59052 for four cycles ( 14763 per cycle) versus 31456 for two cycles of IcE consolidation ( 15728 per cycle). Overall, the classical 7 + 3 ? HiDAC approach ( 102326/ 117089 for three or four consolidation cycles) incurs a greater cost than a HiDAC-3 ? IcE ? 2 approach ( 88358). For patients requiring complete hospitalisation until neutrophil recovery, the estimated costs of treatment will be even higher, ranging between 122282 for HiDAC-3 ? IcE ? 2, 153212 for 7 + 3 ? HiDAC ? 3 and 184937 for 7 + 3 ? HiDAC ? 4. State-based casemix funding for non-complicated AML therapy is currently 74013 for 7