PF289 SOCIOECONOMIC CONSEQUENCES AND OVERALL COSTS PER PATIENT WITH ACUTE MYELOID LEUKAEMIA (AML) IN SWEDEN – A POPULATION‐BASED STUDY USING MULTIPLE NATIONAL REGISTRIES
Authors: Vertuani S. , Redig J. , Hernlund E. , Paulsson B. , Rangert Derolf Å. , Höglund M. , Juliusson G. 
Published: June 2019

Background:

AML affects all ages with an incidence rate of 5 per 100,000, but is much more frequent in older people. The overall lifetime risk of AML is estimated to be 0.5–1%. Long‐term overall survival in younger (age< 60 years) is about 50%, but much worse among older. Although AML therapy is one of the most resource‐intensive cancer treatments, there are few estimates of the resource use and economic burden.

Aims:

The aim of this study was to estimate the cost of treatment of AML in a population‐based setting, and to identify and obtain in‐depth information on treatment‐resource use and costs associated sick leave (SL) and early retirement (ER) in patients with AML.

Methods:

This study was a retrospective database study performed on Swedish national data. Adult patients (age>17 years) diagnosed with AML in Sweden between 2007 and 2015 were identified in the Swedish Cancer Registry, along with vital status. Data on resource use were collected from national registers for inpatient‐ and outpatient specialized care and prescribed drugs. Information on diagnostics and treatment was accessed from the Swedish national AML Registry (SwAMLR). Data on SL and ER came from the Swedish Social Insurance Agency (absent days costed with the mean salary in Sweden). Hospital care resource use was costed using diagnosis‐related group (DRG) remunerations, and include cost of inpatient drugs.

Mean costs per patient were estimated per month for all cost categories and survival was analysed using Kaplan Meier survival estimations. Expected five‐years costs were then estimated by multiplying mean costs with survival estimates for each month, using the method described by Lin et al. to account for right censoring.

Results:

A total of 2,954 adult patients diagnosed with AML between 2007 and 2015 were identified. Approximately 48% of the patient population were female and median age at diagnosis was 71 years. Median survival was estimated at 8 months for the overall population. Expected 5‐year cost per patient was estimated to €80,669. Of this, €57,250 were from costs of hospitalizations, €8,936 from outpatient visits, €3,391 from prescribed drugs, and €11,092 from SL/ER.

In the SwAMLR, 1,772 intensively treated patients were identified, with a median age of 64 years,. Median survival was estimated at 16.8 months. For this patient population, the expected cost per patient over 5 years was estimated to be € 115,830. Of this, €79,762 were from costs of hospitalizations, €12,965 from outpatient visits, €5,147 from prescribed drugs, and €17,956 from SL/ER.

Similarly, patients treated with palliative intent (n = 994) were identified in the SwAMLR. Median age at diagnosis was 81 years. Median survival was estimated at 1.9 months. Expected 5‐year cost per patient was estimated to be €23,291. Of this, €15,783 was from costs of hospitalizations, €4,170 from outpatient visits, €645 from prescribed drugs, and €692 from SL/ER.

Summary/Conclusion:

Previous studies on the economic burden of AML have been limited to specific patient populations or limited to specific treatment events, such as induction therapy. In contrast, this study describes the AML‐associated costs in a nationwide population and includes direct costs as well as indirect costs of productivity losses.

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We found that the society's cost of AML is high, despite the fact that there were few high‐cost drugs used during the study period. Also, in patients with intensive treatment, there are significant costs after the intensive treatment period, in part due to a substantial proretrportion still on sick leave during follow‐up.