Objectives
Costs associated with acute myeloid leukemia (AML) present a considerable economic burden, and the impact of AML on patients’ health-related quality of life (HRQoL) may be substantial. However, the holistic economic and humanistic burdens of AML are not well understood. We conduct a comprehensive review of studies relating to cost-effectiveness/cost-utility and HRQoL for adult transplant-ineligible patients with AML receiving intensive induction chemotherapy.
Methods
SLRs adhering to PRISMA guidelines were performed. A systematic search of MEDLINEâ, EMBASE, NHS EED, and Cochrane Central Register of Controlled Trials from 2005 to 2020 was conducted. A supplementary search of relevant congress abstracts (2018 and 2019) and health technology assessments (HTAs) was also conducted. Two reviewers independently screened study records, assessed study quality, and extracted data.
Results
The economic SLR identified 15 records (14 distinct analyses) that met inclusion criteria: 5 publications, 8 abstracts, and 2 HTA reports. A variety of therapies spanning all treatment phases were evaluated and included midostaurin (induction/consolidation/maintenance; n=11), CPX-351 (induction; n=2), gemtuzumab ozogamicin (induction/consolidation; n=1), and high-dose arabinoside/daunorubicin (consolidation; n=1). No studies were identified that evaluated the cost-effectiveness of maintenance therapy specifically. Across studies, cost-effectiveness was estimated using partitioned survival models (n=12) and state-transition models (n=1). The health-utility SLR identified 18 studies: 8 reported utility values by health state, 10 reported disease-specific HRQoL. The 8 studies reporting health utility values by health state included 4 utility elicitation studies and four economic evaluations. Assessments in the 10 disease-specific HRQoL studies included EORTC QLQ-C30 (n=6), FACT-Fatigue (6), FACT-Leukemia (3), and FACT-General (1). No maintenance-specific utility studies, and no studies reporting EQ-5D, were identified.
Conclusions
Future studies are warranted, as there is a paucity of studies, particularly of maintenance therapies, evaluating the cost-effectiveness and health utilities associated with transplant-ineligible patients with AML receiving intensive induction chemotherapy.
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