Lang Kathleen, Earle Craig C, Foster Talia, Dixon Deirdre, Van Gool Renilt, Menzin Joseph
Boston Health Economics, Inc., Waltham, Massachusetts 02451, USA.
Drugs Aging. 2005;22(11):943-55. doi: 10.2165/00002512-200522110-00004.
Acute myeloid leukaemia (AML) is the most common type of leukaemia among adults in the US. However, data on longitudinal treatment patterns and outcomes associated with AML and its relapse are sparse, particularly among the elderly. This study documents changes in treatment patterns and outcomes among elderly AML patients over the past decade.
Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we retrospectively evaluated trends in mortality, treatment patterns, healthcare resource utilisation and Medicare payments associated with AML and its relapse among Medicare beneficiaries > or =65 years of age who were initially diagnosed with AML in a SEER registry between 1991 and 1999. Chemotherapy was ascertained from examination of inpatient and outpatient bills. AML relapse and retreatment were identified using a validated algorithm. Costs of care were based on total Medicare payments.
A total of 3439 elderly patients with AML were identified. Median survival across all study patients was 2.4 months (mean +/- SD 5.6 +/- 6.8 months), with medians of 3.9, 2.2 and 1.4 months for patients 65-74 years of age, 75-84 years of age and > or =85 years of age, respectively. Fewer than 7% of patients were alive at 2 years, and there was very little variation during the decade of our analysis. Costs and overall healthcare utilisation patterns also changed very little, with the exception of those relating to hospice use and chemotherapy. Hospice use more than doubled during the decade (from 12% to 29% among patients diagnosed in 1991 and 1999, respectively; p < 0.0001), mostly among the oldest patients. Administration of chemotherapy also increased from 29% of patients diagnosed in 1991 to 38% of patients diagnosed in 1999 (p = 0.014), with the increase being seen mostly among younger patients and those treated in teaching hospitals. Average total costs (+/- SD) were US$51,888 +/- $54,825 and declined by age as a result of lower survival. A total of 192 patients (16% of treated patients) relapsed and received retreatment with chemotherapy. These patients survived a median 18 months, with a median duration of remission of 8 months, and average total costs three times higher than the overall sample.
The high early mortality and costs associated with AML have not changed significantly over the past decade. However, treatment patterns appear to be changing, with increasing use of chemotherapy and hospice care. The ongoing introduction of new treatments for AML in the elderly is likely to further impact treatment patterns, and may change the economic burden of the disease. Our findings can be used as a baseline against which the benefits of new therapies can be compared.
急性髓系白血病（AML）是美国成年人中最常见的白血病类型。然而，关于AML及其复发的纵向治疗模式和结局的数据较为稀少，尤其是在老年人中。本研究记录了过去十年中老年AML患者治疗模式和结局的变化。
利用关联的监测、流行病学和最终结果（SEER）-医疗保险数据库，我们回顾性评估了1991年至1999年期间在SEER登记处首次诊断为AML的65岁及以上医疗保险受益人中与AML及其复发相关的死亡率、治疗模式、医疗资源利用和医疗保险支付趋势。化疗情况通过检查住院和门诊账单确定。AML复发和再治疗通过经过验证的算法识别。护理费用基于医疗保险总支付额。
共识别出3439例老年AML患者。所有研究患者的中位生存期为2.4个月（平均±标准差5.6±6.8个月），65 - 74岁、75 - 84岁和85岁及以上患者的中位生存期分别为3.9个月、2.2个月和1.4个月。不到7%的患者在2年时存活，在我们分析的十年间变化很小。成本和总体医疗资源利用模式变化也很小，临终关怀使用和化疗相关情况除外。十年间临终关怀使用增加了一倍多（分别从1991年和1999年诊断患者中的12%增至29%；p < 0.0001），主要发生在最年长的患者中。化疗的使用也从1991年诊断患者中的29%增至1999年诊断患者中的38%（p = 0.014），增加主要见于年轻患者和在教学医院接受治疗的患者。平均总成本（±标准差）为51,888美元±54,825美元，因生存期较短随年龄下降。共有192例患者（占接受治疗患者的16%）复发并接受化疗再治疗。这些患者的中位生存期为18个月，中位缓解期为8个月，平均总成本比总体样本高三倍。
过去十年中，与AML相关的高早期死亡率和成本没有显著变化。然而，治疗模式似乎正在改变，化疗和临终关怀的使用增加。针对老年AML不断引入新的治疗方法可能会进一步影响治疗模式，并可能改变该疾病的经济负担。我们的研究结果可作为比较新疗法益处的基线。
