Microcosting Analysis of Hematopoietic Stem Cell Transplantation and Chemotherapy with Intermediate Doses of Cytarabine in the Treatment of Acute Myeloid Leukemia

Abstract

Abstract Background: Acute myeloid leukemia (AML) is considered a costly disease. Although induction of remission is a critical factor for overall survival (OS) in patients with AML, the fundamental decision after induction is the best post-remission treatment strategy. Depending on risk stratification, the patient may receive consolidation with cycles of intermediate doses of cytarabine, auto-HSCT or allo-HSCT, according to the availability of each service and the availability of a compatible donor. Both strategies are valid for low-risk AML and in the impossibility of an allogeneic or haploidentical transplant also for intermediate risk. Literature data indicate that the safety and effectiveness of consolidation therapy with intermediate dose cytarabine or auto-HSCT do not differ from each other, and the cost can help physicians and health managers in their choice. Methods: We aimed to compare the cost of both treatments of second consolidation in adult patients with de novo AML, 18 - 60 years old, included in the ICAML (International Consortium of Acute Myeloid Leukemia) protocol and analyzed through the microcosting methodology, estimating the direct medical costs of the alternative consolidation therapies under analysis. Results: Retrospectively, from 09/01/15 to 09/01/19, we analyzed 9 patients from the Hospital das Clínicas de Ribeirão Preto, 5 patients treated with auto-HSCT, and 4 patients treated with intermediate doses of cytarabine. The average cost of auto-HSCT was BRL 114.212,78, and that of cytarabine was BRL 121.980,93. Conclusion: In both groups and regardless of the treatment cycle, we observed that the inputs with the greatest economic impact were hospital admissions, mainly due to infections