Cost‐effectiveness of treating childhood acute myeloid leukemia at a tertiary care center in North India

Abstract

AbstractIntroductionChildhood cancers are a significant global health concern, particularly in low‐ and middle‐income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost‐effectiveness of childhood AML treatment in India and other LMICs remain limited.MethodsThe study focused on children (<15 years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment‐related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost‐effectiveness was assessed using disability‐adjusted life years (DALY) averted in relation to the country‐specific cost‐effectiveness threshold.ResultsAmong 59 AML patients, treatment‐related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis‐related complications, with treatment‐related mortality reaching 30%. The 3‐year event‐free survival and overall survival of the 43 patients who received intensive therapy were 24.5% ± 7.6% and 27.9% ± 8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost‐effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost‐effective with a stringent cost‐effectiveness threshold utilized.ConclusionThe study underscores the challenges faced while treating childhood AML in LMICs, including treatment‐induced high sepsis‐related mortality and abandonment. Despite these challenges, it remains cost‐effective to treat childhood AML in India. Future efforts should focus on reducing treatment‐related morbidity and mortality to further improve outcomes and cost‐effectiveness.