Massachusetts General Hospital, Boston, MA, USA.
Bristol Myers Squibb, Princeton, NJ, USA.
Leuk Res. 2023 Sep;132:107353. doi: 10.1016/j.leukres.2023.107353. Epub 2023 Jul 10.
Acute myeloid leukemia (AML) is associated with a substantial clinical and economic burden. This study characterized the magnitude of this burden following initial treatment with standard or less intensive therapies (hypomethylating agents [HMAs]) and throughout different treatment phases post-remission. The Surveillance, Epidemiology, and End Results (SEER) cancer registry (2007-2016) linked with Medicare beneficiary claims (2007-2015) was analyzed. Patients were ≥ 65 years old with AML who initiated chemotherapy or HMAs and achieved remission. Outcomes included baseline characteristics, treatment patterns, clinical outcomes, healthcare resource utilization (HRU), and costs (2019 United States dollar). Economic impacts were stratified by treatment phase (initial treatment, early post-remission, late post-remission, and post-relapse). Early and late post-remission were defined as treatment initiated ≤ 60 days and > 60 days following initial treatment, respectively. A subgroup analysis of patients receiving only HMAs as initial treatment was also conducted. Overall, 530 patients were included (mean age: 74.1 years; 53.6 % male). In the overall analysis, 68.1 % of patients received post-remission treatment; 31.9% had no post-remission treatment. Mean monthly per patient healthcare costs by treatment phase were $45,747 (initial treatment), $30,248 (early post-remission), $23,173 (late post-remission), and $37,736 (post-relapse), driven predominantly by inpatient visits. The HMA subgroup analysis comprised 71 patients (mean age: 78.8 years; 50.7 % male); mean monthly per patient healthcare costs were highest post-relapse. The economic burden of AML among older patients is substantial across all treatment phases. AML treatments that induce and prolong remission may reduce HRU and the economic burden of disease.
急性髓细胞白血病 (AML) 给患者带来了沉重的临床和经济负担。本研究旨在描述初始接受标准或低强度治疗（低甲基化药物 [HMAs]）以及缓解后不同治疗阶段的负担程度。本研究分析了 2007 年至 2016 年期间，SEER 癌症登记处与 Medicare 受益索赔（2007 年至 2015 年）的数据。纳入标准为年龄≥65 岁、初始接受化疗或 HMAs 治疗且缓解的 AML 患者。研究结局包括基线特征、治疗模式、临床结局、医疗资源利用（HRU）和费用（2019 年美元）。经济影响按治疗阶段（初始治疗、早期缓解后、晚期缓解后和缓解后复发）进行分层。早期缓解后和晚期缓解后分别定义为初始治疗后≤60 天和>60 天开始的治疗。还对仅接受 HMA 作为初始治疗的患者进行了亚组分析。共有 530 名患者（平均年龄 74.1 岁，53.6%为男性）纳入研究。总体分析中，68.1%的患者接受缓解后治疗；31.9%的患者未接受缓解后治疗。各治疗阶段患者的人均月医疗费用分别为：初始治疗阶段 45747 美元、早期缓解后阶段 30248 美元、晚期缓解后阶段 23173 美元、缓解后复发阶段 37736 美元，主要由住院治疗产生。HMAs 亚组分析包括 71 名患者（平均年龄 78.8 岁，50.7%为男性），缓解后复发阶段患者的人均月医疗费用最高。在所有治疗阶段，老年 AML 患者的经济负担都很沉重。诱导和延长缓解的 AML 治疗可能会降低 HRU 和疾病的经济负担。
