Overall Economic Burden of Total Treatment Costs in Acute Myeloid Leukemia throughout the Course of the Disease
Authors: Mahmoud Dalia , Skikne Barry S. , Kucmin-Bemelmans Izabela , Alleman Cathelijne , Hensen Marja 
Published: October 2019

Abstract
Abstract 3614

Background:
Acute Myeloid Leukemia (AML) is a common form of leukemia in adults and often requires high resource use. About 84% of the total cost is attributed to hospital payments (Menzin 2002). The aggregate disease burden is difficult to estimate due to multiple complications and treatment courses. The standard treatment modality for AML is intensive chemotherapy with complete remission (CR) achieved in up to 60% of adults with de novo AML who are less than 70 years old (Tallman, 2005), while in the older adults CR rates occur in approximately 45% (Jabbour, 2006). For patients who relapse after CR there are a limited number of efficacious therapeutic options. These include best supportive care (BSC), additional cycles of chemotherapy and stem cell transplantation (SCT) in a minority of patients.

Aim:
To estimate the economic burden of the total treatment costs of AML in patients receiving therapy in the US and UK. Treatment costs are specifically assessed for induction therapy (IT), consolidation therapy (CT), for follow up during CR, and salvage therapy for relapsed or refractory disease.

Methods:
To identify the total costs of AML therapy, a systematic literature review was conducted of standard treatments employed during the past 5 years. Economic costs were estimated per course of treatment which included IT, CT, supportive treatment during CR, and salvage therapy including use of SCT. The total economic burden was calculated combining cost per patient with epidemiology data. Incidence rates for the US and UK and treatment outcome probabilities were calculated from the Surveillance Epidemiology and End Results (SEER), Eurostat and peer reviewed literature. Unit costs were identified using publicly available databases. Calculations were conducted for younger (<65) and older (>65) patients given differences in incidence rates identified between these groups. Costs of treatment were calculated individually for each of the following treatment stages: 1) IT (standard dose chemotherapy (SDC) 1 cycle), 2) CT- 2 cycles of chemotherapy 3) follow up after CR (costs of BSC – 6 cycles), and 4) salvage therapy for relapse refractory disease.

Results:
The costs associated with hospitalization are the main component in all treatment stages (induction, consolidation, and relapse) ranging from 66% to 92% of the total costs. IT plus CT accounted for 19%-91% of the total cost per patient. When combining costs per patient with incidence data, it is estimated that the total economic burden of AML treatment ranges from £13 mln for population >65 and £38 mln for the <65 in the UK and approx. $0.5 billion and $1.5$ billion respectively in US. Not surprising, the cost of transplantation was the highest of all the treatments. The financial burden after relapse is also high compared to the cost of being followed in CR (which consists primarily of the laboratory monitoring and supportive care), namely £683 for BSC, £4,097 for chemotherapy and £82,262 transplantation vs. £4,097 in CR in the UK and $2,477, $56,588 and $154,739 vs. $14,861, respectively in the US. (Table 1).

Summary/Conclusions:
The economic burden of AML treatment is very high. In both the UK and US, hospitalization costs are the key drivers. Findings suggest that savings to the healthcare system could be achieved by sustaining CR status for longer periods. When relapse occurs, high costs are incurred again, particularly when another round of chemotherapy is given. Therefore, besides the fact that achieving and staying in CR is important from the clinical point of view, it has an essential justification from the economic perspective when considering the costs that patients incur after relapse. It is critical to focus on developing new therapies that can prevent relapse and maintain AML patients' CR status to maximize their survival.

Disclosures:
Mahmoud: celgene: Employment. Skikne:Celgene: Employment, Equity Ownership. Kucmin-Bemelmans:Pharmerit BV: Employment. Alleman:Pharmerit BV: Employment. Hensen:Pharmerit BV: Employment.