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[null,null,"This Excel workbook contains the Evidence Map  on \nCost and resource use studies in Acute Myeloid Leukaemia"]
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[null,null,"How this Evidence Map was generated"]
[null,null,"We searched heoro.com on the 5th December 2017 with the following field settings:"]
[null,null,"Disease: Acute Myeloid Leukaemia AND Study type: Cost and Resource Use"]
[null,null,"The search identified a total of 78 relevant abstracts published since 1960, which were  segmented with the following standard heoro.com fields:"]
[null,null,null,"Locations - the geographical setting of the study, or, where this is unknown, the authors' location."]
[null,null,null,"Interventions - the interventions evaluated in the study, if any."]
[null,null,null,"Study types - whether the study reports direct or indirect costs or resource use."]
[null,null,null,"Study methodology - the type of study that was conducted, e.g. clinical trial, observational, systematic review."]
[null,null,null,"Subpopulation - whether the study assessed adults, children, the elderly or an unspecified AML population."]
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[null,null,"In addition the following publication date segmentations are used:"]
[null,null,null,"1960 to 1999, 2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2018"]
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[null,null,"All data in this Evidence Map is taken from the heoro.com database"]
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[null,null,"Details of the PubMed search strategy used to populate the heoro.com database can be found here."]
[]
[null,null,"Contact us:"]
[null,null,"Address: Crystallise Ltd. Unit 21, Thames Enterpise Centre, Thames Industrial Park, East Tilbury, Essex, UK RM18 8RH"]
[null,null,"Tel: +44 (0)1375 488020"]
[null,null,"Email: alison.martin@crystallise.com"]

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[1,"Al-Badriyeh,D.,et al. (2010). \"Pharmacoeconomic evaluation of voriconazole versus posaconazole for antifungal prophylaxis in acute myeloid leukaemia.\" J Antimicrob Chemother 65(5): 1052-1061.",null,"Al-Badriyeh,D.,et al.","Pharmacoeconomic evaluation of voriconazole versus posaconazole for antifungal prophylaxis in acute myeloid leukaemia","BACKGROUND: Voriconazole and posaconazole are used prophylactically against invasive fungal infection (IFI) in patients with acute myeloid leukaemia (AML). The current study attempted to evaluate the economics of voriconazole versus posaconazole for prophylaxis in AML. METHODS: A 6 year (2003-09) retrospective chart review of AML patients was performed at a major Australian tertiary hospital. Patients were followed through the induction stage of chemotherapy,estimating outcome probabilities and prescribing patterns of antifungal prophylaxis. Cost inputs were obtained from the latest Australian sources. A decision analytical model was developed to depict options and consequences involved in the prophylaxis,including success,survival,possible and proven IFIs,and discontinuations due to intolerance. A cost-benefit analysis and an uncertainty study through sensitivity analyses were performed. RESULTS: Fifty-six and 38 patients were evaluated in the voriconazole and posaconazole groups,respectively. Baseline demographic characteristics were not significantly different between the study cohorts. Posaconazole was associated with an overall cost saving of AU$17,458 (29%) per patient over voriconazole. The posaconazole group was associated with lower rate of death,as well as lower probability of discontinuation because of possible infections and intolerance to oral administration. The voriconazole group was associated with fewer proven infections. As per sensitivity analyses,results were highly robust over variations in all costs and probabilities in the model. Monte Carlo simulation suggested a 91.6% chance for posaconazole to cost less than voriconazole. CONCLUSIONS: This is the first economic evaluation of voriconazole versus posaconazole; where posaconazole appears to be more cost-beneficial than voriconazole as antifungal prophylaxis in AML.",null,"Australia",2010,null,"Antifungal",null,"General","Direct","Retrospective Analysis"]
[2,"Aplenc,R.,et al. (2012). \"Merging of the National Cancer Institute-funded cooperative oncology group data with an administrative data source to develop a more effective platform for clinical trial analysis and comparative effectiveness research: a report from the Children's Oncology Group.\" Pharmacoepidemiol Drug Saf 21 Suppl 2: 37-43.",null,"Aplenc,R.,et al.","Merging of the National Cancer Institute-funded cooperative oncology group data with an administrative data source to develop a more effective platform for clinical trial analysis and comparative effectiveness research: a report from the Children's Oncology Group","PURPOSE: The National Cancer Institute-funded cooperative oncology group trials have improved overall survival for children with cancer from 10% to 85% and have set standards of care for adults with malignancies. Despite these successes,cooperative oncology groups currently face substantial challenges. We are working to develop methods to improve the efficiency and effectiveness of these trials. Specifically,we merged data from the Children's Oncology Group (COG) and the Pediatric Health Information Systems (PHIS) to improve toxicity monitoring,to estimate treatment-associated resource utilization and costs,and to address important clinical epidemiology questions. METHODS: COG and PHIS data on patients enrolled on a phase III COG trial for de novo acute myeloid leukemia at 43 PHIS hospitals were merged using a probabilistic algorithm. Resource utilization summary statistics were then tabulated for the first chemotherapy course based on PHIS data. RESULTS: Of 416 patients enrolled on the phase III COG trial at PHIS centers,392 (94%) were successfully matched. Of these,378 (96%) had inpatient PHIS data available beginning at the date of study enrollment. For these,daily blood product usage and anti-infective exposures were tabulated and standardized costs were described. CONCLUSIONS: These data demonstrate that patients enrolled in a cooperative group oncology trial can be successfully identified in an administrative data set and that supportive care resource utilization can be described. Further work is required to optimize the merging algorithm,map resource utilization metrics to the National Cancer Institute Common Toxicity Criteria for monitoring toxicity,to perform comparative effectiveness studies,and to estimate the costs associated with protocol therapy.",null,"USA",2012,null,"Various",null,"General","Resource Use","Clinical trial"]
[3,"Balducci,L.,et al. (1993). \"Cost-effectiveness of white cell-reduction filters in treatment of adult acute myelogenous leukemia.\" Transfusion 33(8): 665-670.",null,"Balducci,L.,et al.","Cost-effectiveness of white cell-reduction filters in treatment of adult acute myelogenous leukemia","The objective of this study was to compare the cost and cost-effectiveness of three transfusion strategies in the treatment of acute myelogenous leukemia: 1) the use of unfiltered pooled platelets until alloimmunization developed and of crossmatch-compatible single-donor platelets thereafter; 2) the use of filtered blood components until alloimmunization occurred and of crossmatch-compatible single-donor platelets thereafter; and 3) the use of single-donor platelets from the beginning. The data sources were English language articles on transfusion medicine in acute leukemia and the management of acute leukemia and review of the transfusion experience at the H. Lee Moffitt Cancer Center. The method was decision analysis with a software program for cost-effectiveness,sensitivity analysis,threshold evaluation,and Monte Carlo sensitivity analysis. In the basic models,the total costs of the first,second,and third strategies are,respectively,$12,557.14,$11,406.17,and $13,016.16 without bone marrow transplant and $14,002.72,$12,281.89,and $13,727.48 with bone marrow transplant. The threshold between the first and second strategies in regard to risk of refractoriness to filtered blood components and pooled platelets was 0.30 and 0.27,respectively,without bone marrow transplant and 0.28 and 0.40 with bone marrow transplant. According to a Monte Carlo sensitivity analysis of 500 samples,the second strategy is more cost-effective than the first in 76 percent of cases. It is concluded that the use of filtered blood components is unlikely to increase the cost of treatment.",null,"USA",1993,null,"Supportive Care",null,"General","Direct","Retrospective Analysis"]
[4,"Barr,R.,et al. (1996). \"Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy.\" J Clin Oncol 14(5): 1413-1420.",null,"Barr,R.,et al.","Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy","PURPOSE: To provide an evidence-based approach to the formulation of clinical policy with respect to allogeneic bone marrow transplantation (BMT) that involves perceived trade offs between two major factors: costs and consequences. The report also highlights key informational deficiencies. PATIENTS AND METHODS: Adults with acute myeloid leukemia (AML) in second complete remission (2CR) and those with acute lymphoblastic leukemia (ALL) in first complete remission (1CR) were assigned to BMT or control groups solely on the availability of a suitable donor. All hospital-borne costs were estimated,based on services used according to manual chart review,in four categories: diagnostic and therapeutic costs,professional fees,drug costs,and ward costs. Incremental costs and incremental life-years were calculated,and the quotient determined a cost per life-year gained by BMT for AML (2CR) and ALL (1CR). RESULTS: The incremental cost (in 1992 Canadian dollars) per life-year gained by BMT (cost-effectiveness) for AML (2CR) was $29,200; and for ALL (1CR) it was minus $29,200. CONCLUSION: For AML (2CR),allogeneic BMT creates better outcomes than standard treatment,but is more costly. For ALL (1CR),both the costs and outcomes are similar for BMT and standard therapy. Quality adjustments made to life-years gained did not change these conclusions.",null,"Canada",1996,null,"Stem Cell Therapy",null,"Adults","Direct","Cohort Study"]
[5,"Bennett,C. L.,et al. (1997). \"Economic analyses of phase III cooperative cancer group clinical trials: are they feasible?\" Cancer Invest 15(3): 227-236.",null,"Bennett,C. L.,et al.","Economic analyses of phase III cooperative cancer group clinical trials: are they feasible?","Both economic and clinical evaluations of new pharmaceutical agents are important to physicians who practice in the current health care environment. While cooperative cancer groups carry out large-scale phase III clinical evaluations of these agents,few cooperative group studies incorporate economic analyses because of concerns over overburdening of data management,investigators,and statistical center personnel. In this study,we describe the results and operational considerations of one of the first completed economic analyses of a phase III cooperative group trial of the Eastern Cooperative Oncology Group (ECOG). We developed an economic model estimating economic benefits of yeast-derived granulocyte-macrophage colony-stimulating factor (GM-CSF) as adjunct therapy for adult patients (56-70 years) with acute myelogenous leukemia. Clinical data were based on prospectively collected information from a recently reported double-blind phase III multi-institutional study carried out by ECOG. Retrospective economic data were obtained from financial information systems at our hospital,one of the study sites. The cost-minimization analyses were based on the perspective of a third-party payer. Indirect costs related to loss of earnings by patients and caregivers as well as quality-of-life adjustments were not incorporated into the model. Clinical trial results indicated that patients treated with GM-CSF had shorter times to recovery of absolute neutrophil count of 500 cells/mm3 and 1000 cells/mm3 and fewer serious infections than patients who received placebo following induction chemotherapy,while no significant differences were noted in red blood cell and platelet transfusion dependency,toxicities,and duration of hospitalization. The economic model estimated that the group treated with GM-CSF was estimated to have lower costs of care,associated with lower frequencies of serious infections and lower overall infection-related costs. Sensitivity analyses indicated that these results held true over a wide range of estimates of costs and infection rates. Prospective economic analyses of phase III cooperative cancer group clinical trials have not been completed to date. Strategies that are not likely to overburden data managers and statistical center personnel are possible to devise. However,these studies require careful planning and coordination between clinical trialists,economists,and health services researchers.",null,"USA",1997,null,"CSF",null,"Adults","Indirect","Retrospective Analysis"]
[6,"Bennett,C. L.,et al. (2001). \"Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): estimates from a Southwest Oncology Group clinical trial.\" Cancer Invest 19(6): 603-610.",null,"Bennett,C. L.,et al.","Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): estimates from a Southwest Oncology Group clinical trial","Considerable morbidity,mortality,and economic costs result during remission induction therapy for elderly patients with acute myeloid leukemia (AML). In this study,the economic costs of adjunct granulocyte colony stimulating factor (G-CSF) are estimated for AML patients > 55 years of age who received induction chemotherapy on a recently completed Southwest Oncology Group study (SWOG). Clinical data were based on Phase III trial information from 207 AML patients who were randomized to receive either placebo or G-CSF post-induction therapy. Analyses were conducted using a decision analytic model with the primary source of clinical event probabilities based on in-hospital care with or without an active infection requiring intravenous antibiotics. Estimates of average daily costs of care with and without an infection were imputed from a previously reported economic model of a similar population. When compared to AML patients who received placebo,patients who received G-CSF had significantly fewer days on intravenous antibiotics (median 22 vs. 26,p = 0.05),whereas overall duration of hospitalization did not differ (median 29 days). The median cost per day with an active infection that required intravenous antibiotics was estimated to be $1742,whereas the median cost per day without an active infection was estimated to be $1467. Overall,costs were $49,693 for the placebo group and $50,593 for the G-CSF patients. G-CSF during induction chemotherapy for elderly patients with AML had some clinical benefits,but it did not reduce the duration of hospitalization,prolong survival,or reduce the overall cost of supportive care. Whether the benefits of G-CSF therapy justify its use in individual patients with acute leukemia for the present remains a matter of clinical judgment.",null,"USA",2001,null,"CSF,Antibiotics",null,"Elderly","Direct","Retrospective Analysis"]
[7,"Bennett,C. L. and G. T. Schumock (2003). \"Cost analyses of adjunct colony stimulating factors for older patients with acute myeloid leukaemia : can they improve clinical decision making?\" Drugs Aging 20(7): 479-483.",null,"Bennett,C. L. and G. T. Schumock","Cost analyses of adjunct colony stimulating factors for older patients with acute myeloid leukaemia : can they improve clinical decision making?","Colony stimulating factors (CSF) have been shown to reduce the duration of neutropenia following intensive chemotherapy in a variety of settings,with many of these studies targeting older patients with leukaemia. We review the clinical and economic findings for use of growth factors for older adults with acute myelogenous leukaemia (AML). The cost analyses were based on the perspective of the third party payer. One study,conducted by the Southwest Oncology Group (SWOG) randomised 207 AML patients to receive granulocyte colony-stimulating factor (G-CSF) or placebo and found no significant difference in number of infections and in days of hospitalisation,3 fewer days with an absolute neutrophil count <500 cells/microL with G-CSF,and an estimated incremental cost of only US 120 dollars with G-CSF over placebo (1997 costs). A second study,conducted by the Eastern Cooperative Oncology Group (ECOG),randomised 119 AML patients to receive granulocyte-macrophage colony-stimulating factor (GM-CSF) or placebo and found a reduction in severe infections,4 fewer days with an absolute neutrophil count <500 cells/microL,no significant difference in the duration of hospitalisation,and estimated cost savings of US 2310 dollars with GM-CSF (1997 costs). These data may be useful to physicians faced with concerns over clinical and economic factors associated with CSF use as adjunct therapy for older persons with AML.",null,"USA",2003,null,"CSF",null,"General","Direct","Narrative Review"]
[8,"Bennett,C. L.,et al. (2000). \"Cost analyses of adjunct colony stimulating factors for acute leukemia: can they improve clinical decision making.\" Leuk Lymphoma 37(1-2): 65-70.",null,"Bennett,C. L.,et al.","Cost analyses of adjunct colony stimulating factors for acute leukemia: can they improve clinical decision making","Colony stimulating factors reduce the duration of neutropenia following intensive chemotherapy in a variety of settings,but the advantages in the management of leukemia are inconclusive. The variations in clinical results and the high costs of granulocyte colony-stimulating factor (G-CSF) and granulocyte macrophage colony-stimulating factor (GM-CSF) have led to confusion over appropriate use for leukemia patients. In this paper,we reviewed published information on costs and cost-effectiveness of growth factors for childhood and adult leukemia patients. Medline and Healthstar databases were searched for original research articles that contain cost or cost-effectiveness analyses of G-CSF (filgrastim) and GM-SCF (sargramostim) in oncology cooperative group trials. Published manuscripts and abstracts presented at national or international oncology conferences were included. The cost of adjunct treatment was evaluated in two studies of pediatric ALL,one study of adult AML,and two studies of AML in older adults (>55 years). The use of G-CSF for children with ALL was associated with reductions in days to ANC recovery,fewer documented infections,a shorter duration of hospitalization,and small (but not significant) additional costs. In adult AML patients,benefits included a shortening of the duration of neutropenia and hospital stays,a lower incidence of infection and febrile episodes,less use of antibiotics,and cost savings of $2,230 and $2,310 in two studies and an increase if $120 in the third study. This summary suggests that economic analyses can provide useful information to assist clinical decision-making. For pediatric ALL patients,this information indicates that G-CSF use is unlikely to have significant cost implications,and its use should be based on clinical considerations. In studies of adult and older adult AML patients,both GM-CSF and G-CSF have clinical benefits and can be expected to lead to a decrease in overall costs.",null,"USA",2000,null,"CSF",null,"Children,Adults,Elderly","Direct","Systematic Review"]
[9,"Bennett,C. L.,et al. (1999). \"Economic analysis of a randomized placebo-controlled phase III study of granulocyte macrophage colony stimulating factor in adult patients (> 55 to 70 years of age) with acute myelogenous leukemia. Eastern Cooperative Oncology Group (E1490).\" Ann Oncol 10(2): 177-182.",null,"Bennett,C. L.,et al.","Economic analysis of a randomized placebo-controlled phase III study of granulocyte macrophage colony stimulating factor in adult patients (> 55 to 70 years of age) with acute myelogenous leukemia. Eastern Cooperative Oncology Group (E1490)","PURPOSE: Considerable morbidity and mortality and costs occur during induction therapy for acute myeloid leukemia (AML). Colony-stimulating factors (CSFs) can shorten neutropenia,and may lower costs. We performed a cost-minimization analysis of granulocyte macrophage colony stimulating factor (GM-CSF) for AML patients > 55 to 70 years of age during an Eastern Cooperative Oncology Group Study. PATIENTS AND METHODS: Clinical data were from a randomized double-blind phase III trial of 117 AML patients. Estimates of costs were from financial accounts from seven participating institutions. Costs were reported from the third party payor perspective. Analyses were conducted utilizing a decision analytic model. The primary source of event probabilities was in-hospital care with or without an active infection. Sensitivity analyses were also reported. RESULTS: When compared to AML patients who received placebo. GM-CSF patients had fewer grade 4-5 infections (9.6% versus 36.2%,P = 0.002) and grade 3-5 infections (52% versus 70%. P = 0.07) and $2.310 in savings. Sensitivity analyses indicated that similar cost estimates applied over a range of clinical and economic assumptions. CONCLUSIONS: This analysis can serve as a template for cooperative group cost analyses. Cooperation on study methodologies may allow for results that are relevant to both clinicians and policy makers.",null,"USA",1999,null,"CSF",null,"Elderly","Direct,Indirect","RCT"]
[10,"Brodin,H. and A. M. Stalfelt (1993). \"Treating acute leukaemias--a venture into economic uncertainty? A method for estimating the cost of treating patients with acute myelocytic leukaemia.\" Acta Oncol 32(5): 501-505.",null,"Brodin,H. and A. M. Stalfelt","Treating acute leukaemias--a venture into economic uncertainty? A method for estimating the cost of treating patients with acute myelocytic leukaemia","The objective of this paper is to report a method for estimating the cost of treating acute myelocytic leukaemia (AML). It is based on individual data from 54 patients treated with aggressive induction courses of chemotherapy. The study records the cost of the entire survival period for 40 patients and of at least 16 months' survival for the remaining 14 patients. All treatment activities were registered from the patient records and the price of each activity was estimated. As far as possible the principle of opportunity cost was used. The median survival time was 50 weeks and the average cost per patient was c. 300,000 SEK (= c. USD 50,000) in 1988 prices. A young man who achieved three remissions and lived for five years had the highest cost,c. 1 million SEK (= USD 155,000). The costs for AML treatment was higher in the 1980s than in the 1970s but led to longer survival for patients who survived the initial period.",null,"Sweden",1993,null,"Conventional Chemo",null,"General","Direct","Retrospective Review"]
[11,"Chan,T. S.,et al. (2016). \"Posaconazole vs fluconazole or itraconazole for prevention of invasive fungal diseases in patients with acute myeloid leukemia or myelodysplastic syndrome: a cost-effectiveness analysis in an Asian teaching hospital.\" J Med Econ 19(1): 77-83.",null,"Chan,T. S.,et al.","Posaconazole vs fluconazole or itraconazole for prevention of invasive fungal diseases in patients with acute myeloid leukemia or myelodysplastic syndrome: a cost-effectiveness analysis in an Asian teaching hospital","BACKGROUND: Posaconazole is superior to fluconazole/itraconazole in preventing invasive fungal diseases (IFDs) in neutropenic patients. Whether the higher cost of posaconazole is offset by decreases in IFDs in a given institute requires cost-effective analysis encompassing the spectrum of IFDs and socioeconomic factors specific to that geographic area. METHODS: This study performed a cost-effective analysis of posaconazole prophylaxis for IFDs in an Asian teaching hospital,employing decision modeling and data of IFDs and medication costs specific to the institute,in neutropenic patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). RESULTS: In the cost-effectiveness analysis,the higher cost of posaconazole was partially offset by a reduction in the cost of treating IFDs that were prevented,resulting in an incremental cost of 125,954 Hong Kong dollars/16,148 USD per IFD avoided. Over a lifetime horizon,assuming same case fatality rate of IFDs in both groups,use of posaconazole results in 0.07 discounted life years saved. This corresponds to an incremental cost of 116,023 HKD/14,875 USD per life year saved. This incremental cost per life year saved in posaconazole prophylaxis fulfilled the World Health Organization defined threshold for cost-effectiveness. CONCLUSION: Posaconazole prophylaxis was cost-effective in Hong Kong.",null,"China",2016,null,"Antifungal",null,"General","Direct","Retrospective Review"]
[12,"Cho,S. Y.,et al. (2015). \"Cost-benefit Analysis of Posaconazole Versus Fluconazole or Itraconazole as a Primary Antifungal Prophylaxis in High-risk Hematologic Patients: A Propensity Score-matched Analysis.\" Clin Ther 37(9): 2019-2027.",null,"Cho,S. Y.,et al.","Cost-benefit Analysis of Posaconazole Versus Fluconazole or Itraconazole as a Primary Antifungal Prophylaxis in High-risk Hematologic Patients: A Propensity Score-matched Analysis","PURPOSE: Posaconazole is effective for the prophylaxis of invasive fungal infections (IFIs) in patients with acute myeloid leukemia or myelodysplastic syndrome during remission induction chemotherapy. However,a cost-benefit analysis of posaconazole versus fluconazole or itraconazole has not been conducted in Korea. METHODS: We retrospectively reviewed data for all consecutive patients who received primary antifungal prophylaxis during remission induction chemotherapy in our acute myeloid leukemia/myelodysplastic syndrome cohort from December 2010 to November 2013. Patient characteristics and factors known as a risk of IFI were matched with propensity score analysis. We evaluated the medical cost according to the prophylactic antifungal agents (posaconazole vs fluconazole/itraconazole),the development of breakthrough IFIs,and survival status after propensity score matching in a 1:1 ratio. FINDINGS: Of the 419 baseline patients,100 patients in each group were analyzed after matching. A significant decrease was found in the development of breakthrough proven or probable IFIs (3.0% vs 14.0%; P = 0.009) and the rate of empirical antifungal therapy (EAFT) (12.0% vs 46.0%; P < 0.001) in the posaconazole group. Total in-hospital medical costs per patient were not statistically different between posaconazole and fluconazole/itraconazole prophylaxis. However,the daily medical cost was lower for posaconazole prophylaxis,resulting in a total daily cost savings of $72 (79,458) per patient (P = 0.002). In the cases of breakthrough proven/probable IFIs,EAFT,and in-hospital deaths,the total medical costs per patient were significantly higher than in nonproven/probable IFIs,non-EAFT,and in-hospital survivors,as much as $7,916 (8,700,758),$4605 (5,062,529),and $11,134 (12,238,422),respectively. Costs for the antifungal agent used in targeted or empirical therapy were lower in the posaconazole group,resulting in a savings of $697 (766,347) per patient (P < 0.001). IMPLICATIONS: Posaconazole appears to be cost beneficial for primary antifungal prophylaxis in high-risk patients with hematologic malignancy,at a single center,in Korea. Cost-benefit is closely related with clinical outcomes,including breakthrough IFI development,EAFT,and survival status.",null,"Republic of Korea",2015,null,"Antifungal",null,"General","Direct","Retrospective Review"]
[13,"Chong,G. L.,et al. (2015). \"Aerosolised liposomal amphotericin B to prevent aspergillosis in acute myeloid leukaemia: Efficacy and cost effectiveness in real-life.\" Int J Antimicrob Agents 46(1): 82-87.",null,"Chong,G. L.,et al.","Aerosolised liposomal amphotericin B to prevent aspergillosis in acute myeloid leukaemia: Efficacy and cost effectiveness in real-life","Chemotherapy-induced neutropenia can be complicated by invasive pulmonary aspergillosis (IPA). In 2008,liposomal amphotericin B (L-AmB) inhalation was shown to prevent IPA in a placebo-controlled trial. Patients with acute myeloid leukaemia (AML) are the subset of haematology patients at high risk for IPA. In 2008,L-AmB inhalation prophylaxis became the standard of care for all AML patients in Erasmus MC. In this study,the efficacy and cost effectiveness of L-AmB inhalation were evaluated in a prospective cohort of AML patients. In total,127 consecutive AML patients received chemotherapy and prophylactically inhaled L-AmB during their first and second chemotherapy cycles; 108 patients treated for AML at the same sites from 2005-2008 served as controls. A standardised diagnostic protocol was used and probable/proven IPA served as the primary endpoint. Diagnostic and therapeutic costs were also comprehensively analysed and compared. A significant decrease in probable/proven IPA in the L-AmB inhalation group was observed (L-AmB 9.5% vs. controls 23.4%; P=0.0064). Systemic antifungal therapy given at any time during the entire AML therapy decreased from 52.8% to 29.9%. Per-patient equipment and drug costs for L-AmB inhalation (1292 euro/patient) were more than compensated for by a decrease in costs for diagnostics and therapeutic voriconazole use (-1816 euro/patient). No serious adverse events related to L-AmB inhalation were observed. In an unselected AML patient group,L-AmB inhalation resulted in a significant and substantial decrease in IPA and was cost saving. Now that azole resistance is more frequent,non-azole-based prophylaxis may become an attractive strategy.",null,"The Netherlands",2015,null,"Antifungal",null,"General","Direct","Cohort Study"]
[14,"Clavio,M.,et al. (2001). \"Cost of de novo acute myeloid leukemia induction therapy in adults: analysis of EORTC-GIMEMA AML10 and FLANG regimens.\" J Exp Clin Cancer Res 20(2): 165-173.",null,"Clavio,M.,et al.","Cost of de novo acute myeloid leukemia induction therapy in adults: analysis of EORTC-GIMEMA AML10 and FLANG regimens","Since the social and financial impact of AML therapy is becoming more and more relevant we analyzed the cost of induction therapy of two different regimens. The first one is part of the widely employed EORTC-GIMEMA AML-10 and consists often days of therapy. The second (FLANG) is a short (three day),Fludarabine,Ara-C,mitoxantrone and G-CSF containing regimen. We first retrospectively analyzed the outcome of 77 consecutive AML patients with comparable clinical and haematological features receiving FLANG (25) or AML-10 (52),between June 1993 and October 1999,and observed equivalent CR rate,as well as DFS and overall survival duration. We then selected 9 non pretreated patients per group who reached CR after one course of therapy. Patients treated with FLANG had a statistically significant earlier platelet recovery compared to those treated with AML-10,fewer days of intravenous antibiotic therapy (14/22,respectively,p < 0.05),and a shorter hospitalization period (22/33 days,p < 0.01). FLANG was significantly more expensive than AML 10 as far as the cost of antiblastic drugs (p < 0.01) and G-CSF support (p < 0.05) are concerned. On the contrary,the expense for antiemetic drugs (p < 0.01) and the cost of personnel and other services ($5,906/$3,970,p < 0.05) were higher for AML-10 than for FLANG. Overall,the average costs of FLANG and AML10 were $9,269 and $12,424 respectively (p < 0.05; difference = -25%). Our study seems to indicate that,compared to AML-10,FLANG induction is as effective,less expensive and it allows for a decrease in the length of hospitalization and thus for better exploitation of the financial resources of Hematology-Oncology departments.",null,"Italy",2001,null,"Conventional Chemo,CSF,Mitoxantrone",null,"General","Resource Use","Retrospective Analysis"]
[15,"Cordonnier,C.,et al. (2005). \"Do minitransplants have minicosts? A cost comparison between myeloablative and nonmyeloablative allogeneic stem cell transplant in patients with acute myeloid leukemia.\" Bone Marrow Transplant 36(7): 649-654.",null,"Cordonnier,C.,et al.","Do minitransplants have minicosts? A cost comparison between myeloablative and nonmyeloablative allogeneic stem cell transplant in patients with acute myeloid leukemia","Allogeneic hematopoietic stem cell transplantation (SCT) is a widely used,cost-intensive procedure. Although pretransplant nonmyeloablative (NMA) or reduced-intensity conditioning regimens appear very promising,prospective studies comparing this approach with the conventional myeloablative (MA) approach in specific hematologic diseases are necessary,especially in patients in whom the conventional approach is not contraindicated. Cost may be an important factor in the decision-making process. We compared the costs of MA and NMA transplants in patients with acute myeloid leukemia (AML). We estimated 1-year resource utilization in 12 consecutive MA patients (median age: 39 years) and in 11 consecutive NMA patients (median age: 58 years) who underwent HLA-identical sibling SCT for AML. Resources care expenses were valued using the average daily rate for personnel costs,supplies,and room costs. Other data were directly collected from the patients' charts. Despite a trend for lower costs in NMA patients during the first 6 months,costs during the 6-12-month period were significantly higher after NMA due to late complications and readmissions (P=0.03). Finally,mean 1-year costs were not different in MA and NMA patients (P=0.75). Prospective studies comparing conventional and NMA approaches in homogeneous populations should include economic items.",null,"France",2005,null,"Stem Cell Therapy",null,"Adults,Elderly","Direct,Indirect,Resource Use","Cohort Study"]
[16,"Costa,V. C.,et al. (2003). \"Resource utilization and cost of episodes of febrile neutropenia in children with acute leukemias and lymphomas.\" Support Care Cancer 11(6): 356-361.",null,"Costa,V. C.,et al.","Resource utilization and cost of episodes of febrile neutropenia in children with acute leukemias and lymphomas","The resource utilization and cost of 51 episodes of febrile neutropenia in children with leukemia and lymphomas who were admitted to the Pediatric Oncology Institute (GRAAC) of the Federal University of Sao Paulo were analyzed. Patients aged 60 days to 21 years with confirmed diagnoses of acute myeloid leukemia,acute lymphoid leukemia,non-Hodgkin lymphoma,or Hodgkins disease who presented axillary temperature above 38 degrees C at least once episode,or between 37.5 degrees C and 38 degrees C on three occasions during a 24-h period,neutrophil count below 500/mm(3),or between 500/mm(3)and 1,000/mm(3) but expected to fall below 500/mm(3) were included in the study. The patients' ages varied between 1 and 15.6 years,and 67% of the patients were male. The median cost per treated episode was US dollars 2,660 (2,039). Hospitalization costs accounted for 62% of the total cost of the treatment,antibacterials accounting for 23%. Episodes in patients with documented infections had a higher median direct cost than episodes in patients with fever of unknown origin (P=0.018). There was a trend for a higher median direct cost in episodes among patients with a worse prognostic factor,such as type of underlying disease,presence of documented infection,and longer duration of neutropenia. This is the first study to evaluate the economics of febrile neutropenia episodes in Brazil,and serves as a basis for resource utilization and costs incurred in the treatment of such patients in this country.",null,"Brazil",2003,null,"Unknown",null,"Children","Direct,Resource use","Retrospective Analysis"]
[17,"Craig,B. M.,et al. (2011). \"Diagnostic testing,treatment,cost of care,and survival among registered and non-registered patients with myelodysplastic syndromes.\" Leuk Res 35(11): 1453-1456.",null,"Craig,B. M.,et al.","Diagnostic testing,treatment,cost of care,and survival among registered and non-registered patients with myelodysplastic syndromes","Considering current reliance on cancer registry data,we sought to assess the potential for bias in myelodysplastic syndrome (MDS) registration using SEER-Medicare data 2001-2005. Using a validated claims-based algorithm,we identified and compared registered and non-registered MDS patients,and found that median cumulative survival was 18 and 28 months,74% and 64% used erythropoiesis-stimulating agents (ESAs),and average 6-month health care cost was $24,249 and $21,750,respectively. While most non-registered MDS patients showed resource utilization and survival characteristics consistent with lower-risk MDS,a subset was registered as acute myeloid leukemia (7.6%) and accounted for early mortality.",null,"USA",2011,null,"Unknown",null,"General","Resource Use,Direct","Retrospective Analysis"]
[18,"Cressman,S.,et al. (2016). \"Economic impact of genomic diagnostics for intermediate-risk acute myeloid leukaemia.\" Br J Haematol 174(4): 526-535.",null,"Cressman,S.,et al.","Economic impact of genomic diagnostics for intermediate-risk acute myeloid leukaemia","Acute Myeloid Leukaemia (AML) is a rare but serious group of diseases that require critical decision-making for curative treatment. Over the past decade,scientific discovery has revealed dozens of prognostic gene mutations for AML while sequencing costs have plummeted. In this study,we compared the cost-effectiveness of multigene integrative analysis (genomic analysis) with the standard molecular testing currently used for diagnosis of intermediate-risk AML. We used a decision analytic model with data for costs and outcomes from British Columbia,Canada,to assess the long-term (10-year) economic impacts. Our results suggest that genomic analysis would result in a 26% increase in the use of first-remission allogeneic stem cell transplantation. The resulting treatment decisions and downstream effects would come at an additional cost of $12 556 [2013 Canadian dollars (CAD)] per person and the incremental cost-effectiveness ratio would be $49 493 per quality-adjusted life-year gained. Cost-effectiveness was dependent on quality of life during the long-term (5-10) years of survival,relapse rates following first-remission chemotherapy and the upfront cost of transplantation. Non-relapse mortality rates,short-term quality of life and the cost of genomic sequencing had only minor impacts. Further research on post-remission outcomes can lead to improvements in the cost-effectiveness of curative treatments for AML.",null,"Canada",2016,null,"Diagnostics",null,"General","Direct","Decision Analytic Model"]
[19,"Dranitsaris,G. and H. Khoury (2011). \"Posaconazole versus fluconazole or itraconazole for prevention of invasive fungal infections in patients undergoing intensive cytotoxic therapy for acute myeloid leukemia or myelodysplasia: a cost effectiveness analysis.\" Support Care Cancer 19(11): 1807-1813.",null,"Dranitsaris,G. and H. Khoury","Posaconazole versus fluconazole or itraconazole for prevention of invasive fungal infections in patients undergoing intensive cytotoxic therapy for acute myeloid leukemia or myelodysplasia: a cost effectiveness analysis","INTRODUCTION: Invasive fungal infections (IFI) remain a clinical concern in hematological patients with prolonged neutropenia because they are a major cause of morbidity and mortality. In a recent randomized trial,prophylaxis with posaconazole was associated with fewer IFI and related deaths relative to a fluconazole or itraconazole (Flu/Itra) control group (p < 0.001). In the current study,a cost effectiveness analysis was conducted to estimate the economic value of posaconazole as an alternative to Flu/Itra when used to prevent IFI in this patient population. METHODS: A decision analysis model was developed using clinical and economic data from randomized comparative trials,the economic literature,and from expert opinion. The data were then used to estimate the incremental cost per life year saved with oral posaconazole prophylaxis relative to Flu/Itra from the Canadian provincial health care system perspective. The base case results were then tested with a sensitivity analysis which evaluated extremes in the incidence of IFI as well as variations in their cost of management. RESULTS: Prophylaxis with posaconazole provides increased efficacy and an overall cost savings of approximately $Can4,259 per patient. Despite variations in the base case parameters,the sensitivity analysis suggested stability in the primary findings. Posaconazole was associated with an overall cost savings (range = $Can1,765 to $Can4,505) in all of the scenarios evaluated. Optimal cost effectiveness was obtained because the drug was able to avoid the more resource intensive Aspergillus infections. CONCLUSIONS: Prophylaxis with posaconazole in cancer patients with prolonged neutropenia is not only cost effective but also cost saving. The economic benefits were due to the drug's ability to reduce the incidence of high cost fungal infections,particularly Aspergillus species.",null,"Canada",2011,null,"Antifungal",null,"General","Direct,Indirect","Decision Analytic Model"]
[20,"Dufoir,T.,et al. (1992). \"Comparative cost of allogeneic or autologous bone marrow transplantation and chemotherapy in patients with acute myeloid leukaemia in first remission.\" Bone Marrow Transplant 10(4): 323-329.",null,"Dufoir,T.,et al.","Comparative cost of allogeneic or autologous bone marrow transplantation and chemotherapy in patients with acute myeloid leukaemia in first remission","We compared the direct costs of allogeneic bone marrow transplantation (Allo-BMT),autologous bone marrow transplantation (Auto-BMT) and chemotherapy (Chemo) in 40 adult patients under the age of 55 years with acute myeloid leukaemia (AML) in first complete remission (CR). Fourteen patients were treated with Allo-BMT,11 with Auto-BMT and 15 with Chemo. These patients,who were part of two cooperative consecutive trials enrolling a total of 196 patients (BGM 84 and BGMT 87 studies),were those who were treated in the CHR Bordeaux and achieved CR after induction chemotherapy. Cost accounting extended over a maximum period of 5 years. The average cost of the procedure for a mean follow-up of 2 years and excluding the cost of treatment after relapse which eventually occurred was significantly higher for the Allo-BMT group (FF 392,724) and the Auto-BMT group (FF 393,461) than for the group that received Chemo (FF 128,947) (p < 0.00001). The average cost for the treatment of relapse was estimated at FF 266,436,irrespective of the previous treatment. The total cost,including the estimated cost of relapse according to its probability of occurring calculated from the original population,was significantly higher for the Allo-BMT group (FF 424,696; p < 0.01) and the Auto-BMT group (FF 505,364; p < 0.0001) than for the Chemo group (FF 304,846).(ABSTRACT TRUNCATED AT 250 WORDS)",null,"France",1992,null,"Stem Cell Therapy,Conventional Chemo",null,"Adults","Direct","Clinical trial"]
[21,"Dunn,C. J. and K. L. Goa (2000). \"Lenograstim: an update of its pharmacological properties and use in chemotherapy-induced neutropenia and related clinical settings.\" Drugs 59(3): 681-717.",null,"Dunn,C. J. and K. L. Goa","Lenograstim: an update of its pharmacological properties and use in chemotherapy-induced neutropenia and related clinical settings","Lenograstim is the glycosylated recombinant form of human granulocyte colony stimulating factor. The drug is used to reduce the risk of life-threatening infection in patients with neutropenia,particularly after cytotoxic chemotherapy. Lenograstim accelerates neutrophil recovery significantly after chemotherapy,with beneficial effects on clinical end-points such as incidence of laboratory-confirmed infection and length of hospital stay. Chemotherapy dose intensity has also been increased in patients receiving lenograstim,notably those with breast or small cell lung cancer,although improvements in tumour response and survival have not been demonstrated. Lenograstim also assists neutrophil recovery in patients undergoing bone marrow transplantation,and stimulates the production of peripheral blood stem cells (PBSCs) for autologous transfusion after aggressive chemotherapy. Lenograstim also mobilises CD34+ cells more efficiently in unit dose terms than filgrastim and has been used successfully to mobilise PBSCs from healthy donors for allogeneic transplantation. Randomised trials have shown increases in rates of disease remission after lenograstim therapy in patients with acute myeloid leukaemia,with no evidence of stimulation of malignant blasts. The drug has also shown potential in the mobilisation of nonmalignant PBSCs for autotransplantation in patients with chronic myeloid leukaemia. Other studies show efficacy of lenograstim in patients with acute lymphoblastic leukaemia,aplastic anaemia,in children with severe chronic neutropenia and in the reversal of neutropenia related to antiviral therapy in patients with AIDS,although data are not extensive. Cost analyses of lenograstim have been carried out from a hospital perspective,although results have been inconclusive. Cost-effectiveness or cost-benefit data are lacking at present. Lenograstim is well tolerated,with bone pain and injection site reactions being reported most frequently in clinical trials. CONCLUSIONS: Lenograstim has been confirmed as a valuable adjunct to minimise the haematological toxicity of myelosuppressive chemotherapy in patients with malignant disease. The drug also enhances neutrophil recovery in patients undergoing stem cell rescue,and assists PBSC mobilisation. Data indicate clinical benefit with lenograstim in myeloid disorders,with no evidence of malignant blast cell proliferation. Further studies are required to assess more fully the pharmacoeconomic implications of the use of lenograstim and other recombinant growth factors,to provide more data on the efficacy of the drug in the management of disease-related neutropenia,and to clarify fully its position relative to filgrastim.",null,"New Zealand",2000,null,"CSF",null,"General","Direct","Retrospective Review"]
[22,"Eardley,A. M.,et al. (1994). \"Morbidity and costs of remission induction therapy with all-trans retinoic acid compared with standard chemotherapy in acute promyelocytic leukemia.\" Leukemia 8(6): 934-939.",null,"Eardley,A. M.,et al.","Morbidity and costs of remission induction therapy with all-trans retinoic acid compared with standard chemotherapy in acute promyelocytic leukemia","With the recent pressure to control health care expenditures,the costs of patient participation in clinical trials,especially in their earliest phases,have come under increasingly intense scrutiny. We therefore reviewed our experience in patients with acute promyelocytic leukemia (APL) who were treated during the first US trial of a new experimental drug,all-trans retinoic acid (RA). The purpose of the review was to evaluate parameters of patient morbidity and financial cost associated with the use of all-trans RA compared with standard chemotherapy for induction of complete remission in newly-diagnosed patients with APL. We retrospectively compared outcomes of consecutive patients treated during the first 2 years of our studies that used all-trans RA for remission induction (1990-1992) with an identical number of patients consecutively treated with standard chemotherapy (cytosine arabinoside plus an anthracycline) during the immediately preceding period (1985-1990). Responding patients in both groups received post-remission chemotherapy. Evaluation parameters included transfusions of packed red blood cells and platelets,use of anti-bacterial and anti-fungal drugs,duration of fever,time to remission,length of hospital stay,hospital charges,and both overall and relapse-free survival. Thirty patients were evaluated in each group. Complete remission was achieved in 26 patients (87%) treated with all-trans RA,and 24 patients (77%) treated with chemotherapy (p = 0.5). In the chemotherapy group,there were five early deaths (four from hemorrhage,one from sepsis); one other patient was resistant to treatment and died at 6 months. Four patients in the all-trans RA group died prior to response from complications of the 'retinoic acid syndrome'. The median time to complete response by all criteria was 41 days (range,18-78) for the all-trans RA group and 50 days (range,24-121) for patients who received conventional chemotherapy (p = 0.2). Looking only at patients who achieved remission,chemotherapy-treated patients required a significantly greater number of platelet transfusions (medians,14 vs. 4; p < 0.001) and packed red blood cell transfusions (15 vs. 4; p < 0.001). Patients who received chemotherapy also experienced a significantly larger number of days with fever (13 vs. 6; p = 0.01) that was reflected in a greater median number of days on combination antibiotics (35 vs. 21; p = 0.001) and Amphotericin B (20 vs. 0; p < 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)",null,"USA",1994,null,"Various,Conventional Chemo",null,"General","Direct,Indirect","Retrospective Review"]
[23,"Edlin,R.,et al. (2010). \"Azacitidine for the treatment of myelodysplastic syndrome,chronic myelomonocytic leukaemia and acute myeloid leukaemia.\" Health Technol Assess 14 Suppl 1: 69-74.",null,"Edlin,R.,et al.","Azacitidine for the treatment of myelodysplastic syndrome,chronic myelomonocytic leukaemia and acute myeloid leukaemia","This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of azacitidine (aza) compared with conventional care regimes (CCR) for higher risk patients with myelodysplastic syndrome (MDS),chronic myelomonocytic leukaemia (CMML) and acute myeloid leukaemia (AML),based on the evidence submission from the manufacturer to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The patient outcomes governing relative effectiveness and cost-effectiveness were defined as overall survival,time to progression (TTP) to AML,adverse events and health-related quality of life (HRQoL). The clinical evidence was derived from an open-label randomised controlled trial referred to as study AZA-001. It compared aza with CCR in 358 patients with higher risk MDS,CMML and AML 20-30% blasts. The outcomes reported in AZA-001 included overall survival,TTP to AML and adverse events. No HRQoL results were reported; however,outcomes likely to impact on HRQoL were provided. The results showed that: the median overall survival was 24.5 months on aza,compared with 15.0 months in the CCR group (p = 0.0001); the response rates were low (complete remission 17% aza versus 8% CCR); the median time to transformation to AML was greater in the aza group (17.8 versus 11.5 months; p < 0.0001); and of patients who were red blood cell (RBC) transfusion-dependent at baseline,45% of those on aza became RBC transfusion-independent during the treatment period,compared with 11.8% in the CCR group (p < 0.0001). The ERG reran the submission's search strategies after some modifications incorporating minor improvements. The ERG analysed the submitted economic model (model 1) and identified a number of inconsistencies and errors within the model. The manufacturer submitted a revised model for analysis by the ERG. Using the issues identified in the earlier analysis,the ERG conducted those repairs to the revised model that were feasible within time constraints. The ERG ran this version in probabilistic sensitivity analyses to generate cost-effectiveness acceptability frontiers. The results of these exploratory analyses indicated that: for standard-dose chemotherapy (SDC)-treated patients,of six treatment options available,best supportive care (BSC) was likely the most cost-effective option up to a threshold of 51,000 pounds/quality-adjusted life-year (QALY) [beyond 51,000 pounds/QALY,aza + low-dose chemotherapy (LDC) became cost-effective]; for LDC-treated patients,of four options available,BSC was again the most cost-effective option up to a willingness-to-pay threshold of 51,000 pounds/QALY (aza + LDC became cost-effective after 51,000 pounds/QALY); for BSC-treated patients,aza + BSC became cost-effective relative to BSC at a threshold of about 52,000 pounds/QALY. The ERG considers these results exploratory and considers that they should be viewed with caution. The AZA-001 study showed that,compared with CCR,those MDS patients receiving aza had prolonged median survival,had delayed progression to AML,had reduced dependence on transfusions and had a small improvement in response rate. Given the general paucity of economic modelling work in MDS and the limitations of the submitted industry model there is an evident need for an independent cost-effectiveness analysis of aza in MDS. At the time of writing,the guidance appraisal consultation document issued by NICE on 4 March 2010 states that azacitidine is not recommended as a treatment option for people not eligible for haemopoietic stem cell transplantation with the the following conditions: intermediate-2 and high-risk MDS according to the International Prognostic Scoring System,CMML with 10-29% marrow blasts without myeloproliferative disorder,or with AML with 20-30% blasts and multilineage dysplasia,according to World Health Organization classification.",null,"UK",2010,null,"Azacitidine",null,"General","Direct","RCT"]
[24,"Eid,K. A.,et al. (2003). \"The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil.\" Braz J Med Biol Res 36(3): 315-321.",null,"Eid,K. A.,et al.","The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil","The feasibility of allogeneic bone marrow transplantation (alloBMT) in a developing country has not yet been demonstrated. Many adverse factors including social and economic limitations may reduce the overall results of this complex and expensive procedure. Our objective was to characterize the most important clinical,social and economic features of candidates for transplantation and their potential donors as well as the influence of these factors on overall survival in a retrospective and exploratory analysis at a university hospital. From July 1993 to July 2001,candidates for BMT were referred to the Bone Marrow Transplantation Unit by Hematology and Oncology Centers from several regions of Brazil. A total of 1138 patients were referred to us as candidates for alloBMT. Median age was 25 years (range: 2 months-60 years),684 (60.1%) were males and 454 (39.9%) were females. The clinical indications were severe aplastic anemia and hematological malignancies. From the total of 1138 patients,923 had HLA-typing; 497/923 (53.8%) candidates had full match donors; 352/1138 (30.8%) were eligible for alloBMT. Only 235 of 352 (66.7%) were transplanted. Schooling was 1st to 8th grade for 123/235 (52.3%); monthly family income ranged from US$60 (7%) to more than US$400 (36%). Overall survival for patients with chronic myeloid leukemia,severe aplastic anemia and acute myeloid leukemia was 58,60 and 30%,respectively. Thus,overall survival rates for the most frequent hematological diseases were similar to those reported in the International Registry,except for acute myeloid leukemia. This descriptive and exploratory analysis suggests the feasibility of alloBMT in a developing country like Brazil.",null,"Brazil",2003,null,"Stem Cell Therapy",null,"General","Unknown","Retrospective Analysis"]
[25,"Flores,A.,et al. (1996). \"Use of all-trans retinoic acid to treat acute promyelocytic leukemia: a case with very severe features at the onset in Nicaragua.\" Med Pediatr Oncol 26(4): 258-260.",null,"Flores,A.,et al.","Use of all-trans retinoic acid to treat acute promyelocytic leukemia: a case with very severe features at the onset in Nicaragua","We observed a child with acute promyelocytic leukemia (APL) who,at the onset,had extremely severe hemorrhagic and septic complications. According to our experience in Nicaragua,there was a very high risk of early death. The patient was successfully treated with a program that included all-trans retinoic acid (ATRA) followed by cytotoxic chemotherapy. ATRA has two important features: it is effective in initial treatment of APL and it is inexpensive. Because of the high cost and the need for extensive supportive care,optimal myeloablative therapy used in patients with various types of acute myeloid leukemia generally cannot be given in developing countries. ATRA treatment for APL is affordable everywhere.",null,"Nicaragua",1996,null,"Various,Conventional Chemo",null,"Children","Unknown","Case Study"]
[26,"Glimelius,B.,et al. (2001). \"The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of chemotherapy effects in some major tumour types--summary and conclusions.\" Acta Oncol 40(2-3): 135-154.",null,"Glimelius,B.,et al.","The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of chemotherapy effects in some major tumour types--summary and conclusions","This report by The Swedish Council on Technology Assessment in Health Care (SBU) reviews,classifies,and grades the scientific literature on cancer chemotherapy in some major tumour types,describes the practice of chemotherapy in Sweden,compares practice with scientific knowledge,and analyses the costs and cost-effectiveness of chemotherapy. The report is intended primarily for decision-makers at various levels,both practitioners and administrators. It is also of interest for the medical profession. The extensive body of scientific literature was reviewed according to strict criteria that reflected the scientific weight of the literature. Sixteen experts representing different disciplines (oncology,surgery,internal medicine,health economy and quality of life research) participated in the literature review. Each section was discussed within the project group and was reviewed by at least one,but usually two international researchers. Additional input was provided by national experts representing different scientific disciplines. For the final evaluation to be as close to the objective truth as possible,a concerted effort was made to guarantee objectivity and thorough assessment of current knowledge about the effects of chemotherapy on the selected cancers. The tumour types selected for this assessment include firstly those types where three investigations had shown an increased use of chemotherapy in Sweden during the latest decade. These were non-small cell lung cancer (NSCLC),gastric cancer,pancreatic cancer,colorectal cancer and urinary bladder cancer. Secondly,the two tumour types comprising the greatest number of patients treated with chemotherapy in Sweden,breast cancer and haematological malignancies,were included. Among the haematological malignancies,the most prevalent ones,acute myeloid leukaemia (AML),chronic lymphocytic leukaemia (CLL),Hodgkin's disease (HD),aggressive non-Hodgkin's lymphoma (NHL) of the large B-cell type and indolent NHL of follicular type were evaluated. These constitute about 75%,of all haematological malignancies. Thirdly,ovarian cancer was included since chemotherapy has been extensively used and since,at the time of the planning of this overview,a group of very expensive drugs,the taxanes,had preliminarily shown promising results. A wealth of scientific literature has been published on cancer therapy. The review presented in this report is limited to scientific studies judged to be important for evaluating chemotherapy efficacy. Assessments of the content and quality of these studies,and a critical summary of the results in all stages of the selected tumours,have never before been attempted in this way. However,similar comprehensive overviews of certain stages of the tumours have previously been made. These overviews were also critically evaluated. Totally 1,496 studies involving 558,743 patients were reviewed. The survey of practice of chemotherapy use involved all departments of surgery,urology,gynaecology,internal medicine including haematologic units,pulmonary medicine and general and gynaecologic oncology at 16 hospitals in two health care regions in Sweden,covering 39% of the Swedish population. During the 4 weeks of the survey,all patients with the diagnoses concerned who received chemotherapy were registered. The study included 1,590 patients. The working group's general conclusions are summarised in the following points: The literature on the effects of chemotherapy is extensive. Chemotherapy has a well-documented role in the curative and palliative treatment of patients with several types of cancer. The use of chemotherapy is of utmost importance for the possibility of cure in certain tumour types. In other tumours,chemotherapy increases the possibility of cure when added to local and regional treatments,particularly surgery. In the instances of no possibility of cure,chemotherapy may to a variable extent improve both patient survival and well-being. In Sweden chemotherapy is largely used in accordance with that documented in the scientific literature. The extent of both over- and under-treatment seems to be limited but cannot be excluded at the individual patient level. The literature-based knowledge is scientifically of lower quality in the most chemotherapy sensitive tumours than in tumours showing more limited sensitivity. In the more sensitive tumours,positive effects on a symptomatic stage and survival were seen several decades ago. In those days,clinical treatment studies did not fulfil the current high quality requirements. Small life-prolonging effects of chemotherapy are sometimes very well documented in large,high quality scientific studies. Some of these s",null,"Sweden",2001,null,"Conventional Chemo",null,"General","Direct","Systematic Review"]
[27,"Greiner,R. A.,et al. (2010). \"Cost-effectiveness of posaconazole compared with standard azole therapy for prevention of invasive fungal infections in patients at high risk in Switzerland.\" Oncology 78(3-4): 172-180.",null,"Greiner,R. A.,et al.","Cost-effectiveness of posaconazole compared with standard azole therapy for prevention of invasive fungal infections in patients at high risk in Switzerland","OBJECTIVE: To evaluate the cost-effectiveness of posaconazole versus standard azoles in the prevention of invasive fungal infection (IFI) in high-risk patients,using a pharmacoeconomic model that was adapted to a Swiss setting. METHODS: Decision tree models based on the results of two registration trials and subsequent Markov models over patient lifetimes were developed for patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) with neutropenia and for hematopoietic stem cell transplant recipients with graft-versus-host disease (GVHD). RESULTS: By reducing IFIs in AML/MDS patients with posaconazole prophylaxis,the contained IFI-related treatment costs more than compensated for the incremental cost of posaconazole,resulting in savings of CHF 1,118 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.16 life years saved per patient compared with fluconazole/itraconazole. In patients with GVHD,posaconazole prophylaxis prevented 0.04 IFIs,resulting in incremental costs of CHF 7,040 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.15 life years saved per patient,with an incremental cost-effectiveness rate of CHF 48,324 per life year saved. CONCLUSIONS: Given the conditions of the Swiss setting,posaconazole can be considered a cost-effective early treatment strategy that increases survival in patients at risk for IFI and may have a substantial benefit for the economic burden of IFI.",null,"Germany",2010,null,"Antifungal",null,"General","Direct","Clinical trial"]
[28,"Heng,S. C.,et al. (2013). \"Pharmacoeconomic evaluation of fluconazole,posaconazole and voriconazole for antifungal prophylaxis in patients with acute myeloid leukaemia undergoing first consolidation chemotherapy.\" J Antimicrob Chemother 68(7): 1669-1678.",null,"Heng,S. C.,et al.","Pharmacoeconomic evaluation of fluconazole,posaconazole and voriconazole for antifungal prophylaxis in patients with acute myeloid leukaemia undergoing first consolidation chemotherapy","BACKGROUND: Fluconazole,posaconazole and voriconazole are used prophylactically in patients with acute myeloid leukaemia (AML). This study evaluated the clinical and economic outcomes of these agents when used in AML patients undergoing consolidation chemotherapy. METHODS: A retrospective chart review (2003-10) of AML patients receiving consolidation chemotherapy was performed. Patients were followed through their first cycle of consolidation chemotherapy. Antifungal prescribing patterns,clinical outcomes and resource consumptions were recorded. A decision analytical model was developed to depict the downstream consequences of using each antifungal agent,with success defined as completion of the designated course of initial antifungal prophylaxis without developing invasive fungal disease (IFD). Cost-effectiveness and sensitivity analyses were performed. RESULTS: A total of 106 consecutive patients were analysed. Baseline characteristics and predisposing factors for IFD were comparable between groups. Three IFDs (one proven,one probable and one suspected) occurred,all in the posaconazole group. Patients receiving posaconazole had the highest rate of intolerance requiring drug cessation (13% versus 7% in each of the fluconazole and voriconazole groups). Fluconazole conferred overall savings per patient of 26% over posaconazole and 13% over voriconazole. Monte Carlo simulation demonstrated a mean cost saving with fluconazole of AU$8430 per patient (95% CI AU$5803-AU$11 054) versus posaconazole and AU$3681 per patient (95% CI AU$990-AU$6319) versus voriconazole. One-way sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: This is the first study to show that,in the setting of consolidation therapy for AML,fluconazole is the most cost-effective approach to antifungal prophylaxis compared with posaconazole or voriconazole.",null,"Australia",2013,null,"Antifungal",null,"General","Direct","Retrospective Review,Decision Analytic Model"]
[29,"Horster,L.,et al. (2017). \"Cost-effectiveness of methods in personalized medicine. Results of a decision-analytic model in patients with acute myeloid leukemia with normal karyotype.\" Leuk Res 62: 84-90.",null,"Horster,L.,et al.","Cost-effectiveness of methods in personalized medicine. Results of a decision-analytic model in patients with acute myeloid leukemia with normal karyotype","BACKGROUND: During the last years,molecular genetic data are increasingly used as prognostic and predictive factors in acute myeloid leukemia (AML). The molecular genetic profile permits a rapid risk categorization and beyond that a prediction of differential treatment efficacy of post-remission chemotherapy versus an allogeneic hematopoietic cell transplantation (HCT) in specific subgroups. METHODS: The aim of this study was to evaluate cost-effectiveness of two different strategies of risk categorization (conventional cytogenetic diagnostics (CCD) versus molecular genetic diagnostics (MGD)) in patients with AML,using a decision-analytic state-transition model. The model is run as (Monte Carlo) microsimulation in which individuals pass through in cycles with a cycle length of one month and a time horizon of ten years. FINDINGS: Results show that on average,individuals within the MGD group generated about US$ 32,000 higher costs but survived about seven months longer than individuals within the CCD group. This leads to an Incremental Cost-Effectiveness Ratio (ICER) of about US$ 4928 per survived month. INTERPRETATION: With a GDP (Gross Domestic Product) of US$ 26,467 (euro 33,630) per capita in Germany in 2012,the base-case ICER of US$ 4928 per survived month projected to US$ 59,136 per survived year is in between the simple GDP and the three times GDP per capita.",null,"Germany",2017,null,"Diagnostics",null,"General","Direct,Indirect","Decision Analytic Model"]
[30,"Huang,B. T.,et al. (2011). \"Analysis of efficacy and cost-effectiveness of high-dose arabinoside versus daunorubicin chemotherapy in older adult patients with acute myeloid leukemia by cytogenetic risk profile: retrospective review from China.\" Int J Hematol 93(4): 474-481.",null,"Huang,B. T.,et al.","Analysis of efficacy and cost-effectiveness of high-dose arabinoside versus daunorubicin chemotherapy in older adult patients with acute myeloid leukemia by cytogenetic risk profile: retrospective review from China","High-dose arabinoside (HiDAC) and daunorubicin (DNR)-based chemotherapy are the primary consolidation treatment options for older adults (50-60 years old) with acute myeloid leukemia in China. We analyzed the event-free survival (EFS) and hospital treatment charges of older adult patients with different cytogenetic risk profiles. In patients with a better/intermediate risk profile,the average total treatment cost of HiDAC was similar to that of DNR (P = 0.11). A 5-year follow-up of patients with better/intermediate cytogenetic risk profiles revealed that the median EFS of patients who received HiDAC was significantly longer than for patients who received the DNR-based regimen (27 vs. 20 months,P = 0.03). Average cost per year of life saved was 18,746.84 USD for HiDAC,compared to 32,733.37 USD for DNR. In contrast,for patients with a poor cytogenetic risk profile,the average total treatment cost for HiDAC was higher than for DNR (P < 0.005). In addition,the median EFS in the HiDAC protocol group was significantly lower than in the DNR group (11 vs. 20 months,P = 0.003). Meanwhile,in this risk group,the average cost per year of life saved was 103,237.70 USD compared to 32,277.93 USD,respectively,in the HiDAC and DNR regimens. We conclude that HiDAC is a more efficacious and cost-effective consolidation treatment regimen in the better/intermediate risk group,while the DNR-based regimen is more cost-effective in the poor risk group.",null,"China",2011,null,"Conventional Chemo",null,"Elderly","Direct","Retrospective Review"]
[31,"Imataki,O.,et al. (2010). \"Cost and effectiveness of reduced-intensity and conventional allogeneic hematopoietic stem cell transplantation for acute myelogenous leukemia and myelodysplastic syndrome.\" Support Care Cancer 18(12): 1565-1569.",null,"Imataki,O.,et al.","Cost and effectiveness of reduced-intensity and conventional allogeneic hematopoietic stem cell transplantation for acute myelogenous leukemia and myelodysplastic syndrome","GOALS OF WORK: Allogeneic stem cell transplantation with a reduced-intensity regimen (RIST) has been evaluated mostly in terms of its clinical benefit,and the pharmacoeconomic aspects of this procedure remain unclear. We compared the cost and effectiveness of RIST with those of stem cell transplantation using a conventional myeloablative regimen (CST). PATIENTS AND METHODS: Fifty consecutive patients who underwent transplantation for myeloid malignancy were included. Life years and medical costs during the entire treatment course for up to 2 years after transplantation were evaluated,and cost-effectiveness was assessed from the payer's perspective. MAIN RESULTS: Of these 50 cases,35 were treated with CST and 15 were treated with RIST. The mean survival time was 1.5 years in CST and 1.2 years in RIST,while the mean total cost per patient within the first 2 years was $29,630 for CST and $29,466 for RIST,with no significant difference. The duration of total hospitalization was shorter in RIST than in CST; then,the cost for hospitalization represented a lower proportion of the total cost in RIST (49% of total cost) than in CST (63%). In contrast,the cost related to the conditioning regimen was significantly higher in RIST than in CST. CONCLUSIONS: This result suggests that the increased cost of the conditioning regimen offsets the reduced cost of hospitalization in RIST. Although some differences were observed in the details of the cost,the total cost and mean survival were comparable between CST and RIST,and this result was confirmed by a probabilistic sensitivity analysis.",null,"Japan",2010,null,"Conventional Chemo,Stem Cell Therapy",null,"General","Direct","Cohort Study"]
[32,"Inaba,H.,et al. (2011). \"Randomized trial of 2 dosages of prophylactic granulocyte-colony-stimulating factor after induction chemotherapy in pediatric acute myeloid leukemia.\" Cancer 117(6): 1313-1320.",null,"Inaba,H.,et al.","Randomized trial of 2 dosages of prophylactic granulocyte-colony-stimulating factor after induction chemotherapy in pediatric acute myeloid leukemia","BACKGROUND: Granulocyte-colony-stimulating factor (G-CSF) is effective in accelerating neutrophil recovery after intensive chemotherapy for acute myeloid leukemia (AML). However,the optimal G-CSF dosage for patients with AML has not been determined. To the authors' knowledge,G-CSF dosages have not been compared in a randomized AML study. METHODS: Patients who were enrolled on the St. Jude AML97 protocol and remained on study after window therapy were eligible to participate. The effect of the dosage of G-CSF given after induction chemotherapy Courses 1 and 2 was analyzed in 46 patients who were assigned randomly in a double-blinded manner to receive either 5 mug/kg daily or 10 mug/kg daily of G-CSF. The number of days of G-CSF treatment,neutropenia (an absolute neutrophil count <0.5 x 10(9) /L),and hospitalization; the number of episodes of febrile neutropenia,grade 2 through 4 infection,and antimicrobial therapy; transfusion requirements; the cost of supportive care; and survival were compared between the 2 study arms. RESULTS: No statistically significant differences were observed between the 2 arms in any of the endpoints measured. CONCLUSIONS: The higher G-CSF dosage (10 mug/kg daily) offered no greater benefit than the lower dosage (5 mug/kg daily) in patients who were receiving intensive chemotherapy for AML.",null,"USA",2011,null,"CSF",null,"General","Resource Use","Cohort Study"]
[33,"Irish,W.,et al. (2017). \"Acute myeloid leukemia: a retrospective claims analysis of resource utilization and expenditures for newly diagnosed patients from first-line induction to remission and relapse.\" Curr Med Res Opin 33(3): 519-527.",null,"Irish,W.,et al.","Acute myeloid leukemia: a retrospective claims analysis of resource utilization and expenditures for newly diagnosed patients from first-line induction to remission and relapse","OBJECTIVE: The objective of this study was to estimate resource utilization and expenditures for patients with acute myeloid leukemia (AML) in a real-world claims database. RESEARCH DESIGN AND METHODS: AML patients were identified in MarketScan claims databases between 1 January 2009 and 31 January 2015. Patients had a minimum of two AML diagnosis codes,hospitalization within 14 days after initial diagnosis,and >/=6 months of enrollment before initial diagnosis. Patients were monitored from first-line induction to a record of remission. A subset had a record of a second treatment period,defined as time from relapse to remission. Patient demographics,AML risk factors,and comorbidities were recorded. Descriptive analysis of utilization and expenditures (in 2014 $US) were reported for each cohort. RESULTS: The inclusion criteria were met in 1597 patients (mean age,58.4 years; 51.0% male). Ninety percent of patients had >/=1 risk factor for AML. Mean (SD) healthcare expenditures for patients from first-line induction to remission (n = 681) were $208,857 ($152,090). Of the 157 who had a record of relapse,70 had a record of a second remission. Expenditures for these patients (n = 70) from relapse to remission were $142,569 ($208,307); 60% were admitted to a hospital for a mean of 18.5 hospital days,and 20% had >/=1 emergency room visit. CONCLUSIONS: Although this claims-based analysis is limited by a lack of generalizability to noninsured populations and potential underreporting of certain events and diagnoses,we found that treating AML patients poses a significant healthcare burden,during both first-line induction and relapse. With people living longer,the number of cases of AML is expected to increase in the future.",null,"USA",2017,null,"Unknown",null,"Elderly","Resource Use","Retrospective Analysis"]
[34,"Jiang,H.,et al. (2015). \"Reduced medical costs and hospital days when using oral arsenic plus ATRA as the first-line treatment of acute promyelocytic leukemia.\" Leuk Res 39(12): 1319-1324.",null,"Jiang,H.,et al.","Reduced medical costs and hospital days when using oral arsenic plus ATRA as the first-line treatment of acute promyelocytic leukemia","We have demonstrated that oral arsenic (Realgar-Indigo naturalis formula,RIF) plus all-trans retinoic acid (ATRA) is not inferior to intravenous arsenic trioxide (ATO) plus ATRA as the first-line treatment of acute promyelocytic leukemia (APL). To compare the cost-effectiveness of oral and intravenous arsenic,we analyzed the results of 30 patients in each group involved in a randomized controlled trial at our center. The median total medical costs were $13,183.49 in the RIF group compared with $24136.98 in the ATO group (p<0.0001). This difference primarily resulted from the different costs of induction therapy (p=0.016) and maintenance treatment (p<0.0001). The length of hospitalization for the RIF group was significantly lower than that for the ATO group (24 vs. 31 days,p<0.0001) during induction therapy. During maintenance treatment,the estimated medical costs were $2047.14 for each patient in the RIF group treated at home compared with $11273.81 for each patient in the ATO group treated in an outpatient setting (p<0.0001). We conclude that oral RIF plus ATRA significantly reduced the medical costs and length of hospital stay during induction and remission therapy compared with ATO plus ATRA in APL patients.",null,"China",2015,null,"Various",null,"General","Direct","RCT"]
[35,"Kaito, K., et al. (1998). \"Combination chemotherapy with G-CSF, M-CSF and EPO: successful treatment for acute myelogenous leukemia without blood transfusion at lower medical costs.\" Acta Haematol 100(1): 57-60.",null,"Kaito, K., et al.","Combination chemotherapy with G-CSF, M-CSF and EPO: successful treatment for acute myelogenous leukemia without blood transfusion at lower medical costs","A 55-year-old Jehova's Witness was treated for acute myelogenous leukemia (AML) by intensive chemotherapy with enocitabine, 6-mercaptopurine and daunorubicin. G-CSF, M-CSF and EPO were subsequently administered. Even though no blood transfusion was given for religious reasons, complete remission was achieved without serious infection and hemorrhage. The total cost for induction chemotherapy was less expensive than is the case for elderly AML patients. This case indicates that the administration of cytokines might reduce the incidence of infection and the necessity for blood products, which would result in favorable cost effectiveness for the treatment of elderly patients with AML.",null,"Japan",1998,null,"CSF,Conventional Chemo,Enocitabine",null,"Elderly","Direct","Case Study"]
[36,"Kasteng, F., et al. (2007). \"Economic evaluations of leukemia: a review of the literature.\" Int J Technol Assess Health Care 23(1): 43-53.",null,"Kasteng, F., et al.","Economic evaluations of leukemia: a review of the literature","OBJECTIVES: Leukemia, together with lymphoma and multiple myeloma, are hematological malignancies, malignancies of the blood-forming organs. There are four major types of leukemia: acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL). There is a growing amount of literature of the health economic aspects of leukemia. However, no comprehensive review is yet performed on the health economic evidence for the disease. Hence, our aim was to review and analyze the existing literature on economic evaluations of the different types of leukemia. METHODS: A systematic literature search used electronic databases to identify published cost analyses and economic evaluations of leukemia treatments. After reviewing all identified studies, sixty studies were considered relevant for the purpose of the review. RESULTS: The identified studies were published after 1990, with a few exceptions. Many of the identified economic evaluations in leukemia, particularly for ALL and AML, may be defined as cost-minimization analyses, where only the costs of different treatment strategies are compared. In CML, a new treatment, imatinib, was introduced in 2001 and several cost-effectiveness analyses have since then been conducted comparing imatinib with previous first line treatments. CONCLUSIONS: This review indicates that there is a shortage of cost-effectiveness information in leukemia. The introduction of new therapies will stress the need for new economic evaluations in this group of diseases. More information about the total costs, that is, including indirect costs, and quality of life effects would be valuable in future evaluations in leukemia.",null,"Sweden",2007,null,"Unknown",null,"Unknown","Direct,Indirect","Systematic Review"]
[37,"Kruse, M., et al. (2015). \"Budgetary impact of treating acute promyelocytic leukemia patients with first-line arsenic trioxide and retinoic acid from an Italian payer perspective.\" PLoS One 10(8): e0134587.",null,"Kruse, M., et al.","Budgetary impact of treating acute promyelocytic leukemia patients with first-line arsenic trioxide and retinoic acid from an Italian payer perspective","The objective of this study was to estimate the net cost of arsenic trioxide (ATO) added to all-trans retinoic acid (ATRA) compared to ATRA plus chemotherapy when used in first-line acute promyelocytic leukemia (APL) treatment for low to intermediate risk patients from the perspective of the overall Italian healthcare systemA Markov model was developed with 3 health states: stable disease, disease event and death. Each month, patients could move from stable to disease event or die from either state. After a disease event, patients discontinued initial treatment and switched to the other regimen as second-line therapy. Treatment regimens, efficacy and adverse events were derived from published sources and expert opinion; unit costs were collected from standard Italian sources. Clinical outcomes and costs for pre-ATO and post-ATO scenarios were combined with population and product utilization information to calculate the total budgetary impact using a 3-year time horizon; one-way sensitivity analyses were conducted. Three-year cumulative pharmacy costs for ATO+ATRA were euro46,700 per-patient versus euro6,500 for ATRA+chemotherapy; however, medical costs for ATO+ATRA were euro12,300 per-patient versus euro30,200 for ATRA+chemotherapy. The total budgetary impact was estimated to be an additional euro127,300, euro312,500 and euro477,800 in the first, second and third years, respectively. The model was most sensitive to changes in the cost of the ATO+ATRA regimen during the consolidation phase. Budgetary impact models are valuable to payers making formulary decisions regarding the access and affordability of new medicines. The cost of treatment analysis showed that pharmacy costs for ATO+ATRA were higher than for ATRA+chemotherapy, while all other evaluated costs were lower for ATO+ATRA treated patients. The average budgetary impact was euro305,900 per year overall, representing a 3.5% increase. Further research is needed to determine the cost-effectiveness of ATO+ATRA compared to the current first-line standard of care in APL.",null,"USA,Germany,Italy,UK",2015,null,"Various,Conventional Chemo",null,"General","Direct","Cohort Study"]
[38,"Kuse, R., et al. (2001). \"Which factors render cost-covering lump-sum charging difficult for the treatment of patients with acute leukemias?\" Onkologie 24(3): 292-294.",null,"Kuse, R., et al.","Which factors render cost-covering lump-sum charging difficult for the treatment of patients with acute leukemias?","BACKGROUND: Growing budget limitations and the planned charging subject to Diagnosis-Related Groups (DRG) points raise the question as to what costs are incurred by the induction therapy and early consolidation treatment of patients with acute myeloid leukemias (AML) and whether these can be compensated in a cost-covering manner by a system based on DRG points. PATIENTS AND METHODS: For 100 patients recruited within the framework of the \"Kooperative AML-Studie 96\" of the Suddeutsche Hamoblastosegruppe a process cost analysis was made between 1996 and 1999. All manpower and material costs incurred in the department itself and in the secondary services departments as well as the basic cost shares were recorded taking into due account the length of stay. The cost breakdown was effected based on a double induction therapy and one early consolidation treatment. RESULTS: It turns out that substantial differences exist between lower und upper limits of the length of stay and costs. For all three therapy blocks for patients up to 60 years the cost spread varies between 63 and 204 kDM with a median of 105 kDM, and for older patients between 55.6 and 146.6 kDM with a median of 87.6 kDM. On average, the costs subject to length of stay were roughly 70%. CONCLUSIONS: As the costs per case are subject to a spread and, for this relatively small group of patients, are extremely high, the fixing of a case-related lump sum is problematic, the more so as age of patient, comorbidity, type of therapy, ist outcome, and therapy-induced complications represent decisive influencing factors.",null,"Germany",2001,null,"Conventional Chemo",null,"General","Direct","Retrospective Analysis"]
[39,"Lachaine, J., et al. (2015). \"Economic evaluation of arsenic trioxide compared to all-trans retinoic acid + conventional chemotherapy for treatment of relapsed acute promyelocytic leukemia in Canada.\" Eur J Haematol 95(3): 218-229.",null,"Lachaine, J., et al.","Economic evaluation of arsenic trioxide compared to all-trans retinoic acid + conventional chemotherapy for treatment of relapsed acute promyelocytic leukemia in Canada","OBJECTIVES: Acute promyelocytic leukemia (APL) is an uncommon type of acute leukemia characterized by high early mortality. Current first-line treatments include all-trans retinoic acid (ATRA), anthracyclines, and other conventional chemotherapies (CTs). Although APL is generally associated with a good prognosis, about 20% of patients who achieve remission subsequently relapse and are resistant to the previously administrated treatment. The objective of this study was to assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) compared to ATRA+CT for treatment of patients with relapsed/refractory APL. METHODS: The cost-effectiveness of ATO compared to ATRA+CT for treating patients with relapsed/refractory APL was assessed over a lifetime horizon using a Markov model. The model considers five health states: induction, second remission, treatment failure or relapse, postfailure, and death. Markov cycle length was 1 month for the first 24 months and 1 yr thereafter. The model also takes into account the incidence of grade 3-4 adverse events reported in clinical trials. Analyses were conducted from a Canadian Ministry of Health (MoH) and a societal perspective. RESULTS: Compared to ATRA+CT, ATO was associated with incremental cost-effectiveness ratios of $ 20,551/quality-adjusted life year (QALY) from a MoH perspective and $ 22,219/QALY from a societal perspective. Results of the probabilistic sensitivity analysis indicated that ATO is a cost-effective strategy in 99.27% and 98.98% of the simulations from a MoH and a societal perspective, respectively. CONCLUSIONS: This economic evaluation demonstrates that ATO is a cost-effective strategy compared to ATRA+CT for treatment of patients with relapsed/refractory APL in Canada.",null,"Canada",2015,null,"Various,Conventional Chemo",null,"General","Direct,Indirect","Cohort Study"]
[40,"Lachaine, J., et al. (2015). \"Economic evaluation of arsenic trioxide for treatment of newly diagnosed acute promyelocytic leukaemia in Canada.\" Hematol Oncol 33(4): 229-238.",null,"Lachaine, J., et al.","Economic evaluation of arsenic trioxide for treatment of newly diagnosed acute promyelocytic leukaemia in Canada","To assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) + all-trans retinoic acid (ATRA) for treating newly diagnosed acute promyelocytic leukaemia (APL), the cost-effectiveness of ATO + ATRA compared to ATRA + idarubicin (IDA) was assessed over a lifetime horizon using a time-dependent Markov model. The model considers four health states: complete remission, treatment failure or relapse, post-failure, and death. Markov cycle length was 1 month for the first 48 months and 1 year thereafter. Efficacy outcomes in terms of event-free survival and overall survival were taken from a head-to-head clinical trial. Costs were associated with drug and administration, adverse events (AEs), treatment of relapses, follow-up visits, and productivity losses. Utilities and disutilities associated with health states and AEs were derived from the literature. Compared to ATRA + IDA, ATRA + ATO is associated with incremental cost-effectiveness ratios (ICERs) of $CAD50,193/quality-adjusted life years (QALY) and $CAD50,338/QALY from a Canadian Ministry of Health (MoH) and societal perspectives, respectively. Results of the one-way sensitivity analysis show that ICER varied from $CAD23,045 to $CAD60,759/QALY (MoH perspective) and from $CAD23,120 to $CAD60,905/QALY (societal perspective). ATO in the first-line therapy for patients with APL can be considered a more cost-effective strategy than standard treatment from a Canadian perspective.",null,"Canada",2015,null,"Various,Conventional Chemo",null,"General","Direct","Cohort Study"]
[41,"Leunis, A., et al. (2013). \"The costs of initial treatment for patients with acute myeloid leukemia in the Netherlands.\" Leuk Res 37(3): 245-250.",null,"Leunis, A., et al.","The costs of initial treatment for patients with acute myeloid leukemia in the Netherlands","The aim of this study was to calculate the costs of the current initial treatment of acute myeloid leukemia. Resource use was collected for 202 patients who started with intensive chemotherapy in 2008 or 2009. The costs of the first induction course were significantly higher than the costs of the second induction course. Allogeneic transplantation from a matched unrelated donor was significantly more expensive than the other consolidation treatments. In-hospital stay was the major cost driver in the treatment of AML. Research regarding possibilities of achieving the same or better health outcome with lower costs is warranted.",null,"The Netherlands",2013,null,"Unknown",null,"General","Resource Use","Retrospective Analysis"]
[42,"Luo, X. Q., et al. (2009). \"Improved outcome for Chinese children with acute promyelocytic leukemia: a comparison of two protocols.\" Pediatr Blood Cancer 53(3): 325-328.",null,"Luo, X. Q., et al.","Improved outcome for Chinese children with acute promyelocytic leukemia: a comparison of two protocols","OBJECTIVE: Acute promyelocytic leukemia (APL) is now highly curable, except in many developing countries. Introduction of current treatment strategies may improve the outcome for children with APL in these countries. METHODS: The diagnosis was based on the FAB classification and detection of PML-RAR alpha rearrangement. From December 1999 to September 2004, 16 eligible children were treated with an intensive in-house protocol including high-dose AraC and anthracycline. Subsequently, 14 cases were treated with a less intensive protocol modified from the PETHEMA LPA99. RESULTS: The 3.5 years event-free survival (EFS) was 37.5% (95% CI, 13.8-61.2%) for patients treated on initial protocol. The treatment failures were: six patients abandoned treatment (37.5%), two who died of intracranial hemorrhage at diagnosis (6.3%) and sepsis in remission (6.3%) respectively, and two who relapsed (12.5%). Those treated on modified PETHEMA had a 3.5 years EFS of 79.6% (95% CI, 52.9-106.3%). Treatment failures included: one who died of intracranial hemorrhage at diagnosis (7.1%) and one who relapsed (7.1%). The patients on modified PETHEMA had a significantly higher EFS (P = 0.012), lower frequency of sepsis during treatment (7.7% vs. 77.8%; P = 0.0015), and lower hospitalization cost (median US$ 4,700 vs. US$ 20,000; P < 0.0001) than those on in-house protocol. CONCLUSION: Treatment with the less intensive protocol based on the PETHEMA LPA99 study of childhood APL successfully reduced chemotherapy toxicity and lowered hospitalization costs without increasing relapses. This led to decreases in treatment-related morbidity and the treatment abandonment rate, thus improving overall outcome.",null,"China",2009,null,"Conventional Chemo",null,"Children","Direct","Cohort Study"]
[43,"Marie, J. P., et al. (1992). \"Cost of complete remission induction in acute myeloblastic leukemia: evaluation of the cost-effectiveness of a new drug.\" Leukemia 6(7): 720-722.",null,"Marie, J. P., et al.","Cost of complete remission induction in acute myeloblastic leukemia: evaluation of the cost-effectiveness of a new drug","The use of new drugs in the treatment of AML could dramatically increase the cost of induction chemotherapy. To evaluate the cost-effectiveness of such new drugs, the overall cost to achieve complete remission (CR) with treatments including these drugs has to be compared to the cost of the daunorubicin-cytosine arabinoside (DNR-AraC) association, considered as the reference treatment. A retrospective analysis of charts from 15 patients treated with DNR-AraC was used to identify 228 items of cost, including general cost, diagnostic, supportive care, and chemotherapy. Eleven patients underwent CR after one course of chemotherapy for a cost of US$16,701 +/- 4451, and four patients achieved CR after two courses for a cost of US$37,130 +/- 4923. The chemotherapy represented only 1.4% of the total cost, supportive care 25% and general cost 56%. According to these data, the projective cost of a treatment with mitoxantrone instead of DNR was simulated in 40 untreated patients with AML. The better rate of CR obtained after one course of chemotherapy leads to a saving of 9% (US$1261) per patient, despite the higher cost of chemotherapy. Cost-effectiveness evaluation should be included in the clinical study of trials with new drugs.",null,"France",1992,null,"Conventional Chemo",null,"General","Direct,Indirect","Retrospective Analysis"]
[44,"Menzin, J., et al. (2002). \"The outcomes and costs of acute myeloid leukemia among the elderly.\" Arch Intern Med 162(14): 1597-1603.",null,"Menzin, J., et al.","The outcomes and costs of acute myeloid leukemia among the elderly","BACKGROUND: The incidence of acute myeloid leukemia (AML) among the elderly can be expected to grow as the population continues to age. However, data on current treatment practices and costs for this form of cancer are sparse. METHODS: We used a retrospective inception cohort design and data from a linkage between 11 Surveillance, Epidemiology, and End Results cancer registries and Medicare administrative claims. We evaluated survival, use of health care resources, use of chemotherapy, and Medicare payments among adults 65 years and older with an initial diagnosis of AML between January 1, 1991, and December 31, 1996. RESULTS: A total of 2657 elderly patients with AML and complete Medicare claims data were identified. The prognosis for these patients was poor, with median survival estimated to be 2 months and a 2-year survival rate of 6%. Mean +/- SE total Medicare payments were $41,594 +/- $870 (in 1998 US dollars), 84% of which was attributed to inpatient payments. In the 2 years after the AML diagnosis, 790 patients (30%) underwent chemotherapy treatment. These patients had costs almost 3 times higher than those of other patients, and their median survival was 6 months longer. The use of hospice care was rare (17% of patients). CONCLUSIONS: Among the elderly, AML is associated with a poor prognosis and substantial costs during the relatively few remaining months of life. Moreover, most patients do not receive active treatment with chemotherapy or hospice services. Further work is needed to characterize this disease and the patient-related factors that influence treatment decisions and associated health outcomes.",null,"USA",2002,null,"Conventional Chemo",null,"Elderly","Direct,Resource use","Retrospective Review"]
[45,"Meyers, J., et al. (2013). \"Medicare fee-for-service enrollees with primary acute myeloid leukemia: an analysis of treatment patterns, survival, and healthcare resource utilization and costs.\" Appl Health Econ Health Policy 11(3): 275-286.",null,"Meyers, J., et al.","Medicare fee-for-service enrollees with primary acute myeloid leukemia: an analysis of treatment patterns, survival, and healthcare resource utilization and costs","BACKGROUND: Acute myeloid leukemia (AML) is the most common form of acute leukemia affecting adults, with incidence increasing with patient age. Previous studies have found that older AML patients, constituting the majority of the AML population, generally have poor outcomes, high healthcare expenditures, and median survival of <3 months. Because up-to-date information on treatment patterns, survival trends, and costs of care for elderly AML patients are lacking in the literature, we examined Medicare fee-for-service enrollees with primary AML to update these estimates and report on changes in treatment for this population. OBJECTIVE: The primary objective of this study was to examine real-world data on treatment patterns, survival, and costs in elderly patients with primary AML. Factors associated with receipt of chemotherapy and with mortality also were assessed. METHODS: This is a retrospective database analysis using the Surveillance, Epidemiology, and End Results cancer registry and linked Medicare claims. Patients aged 65 years and older, who were newly diagnosed with AML between 1 January 1997 and 31 December 2007 were selected if they had no previous neoplasm or hematological disease. Patients were followed until death or to the end of the observation period (31 December 2007). Study measures included chemotherapy and supportive care (SC) received, survival time, and all-cause healthcare utilization and costs accrued from AML diagnosis until death or observation period end. Regression analyses assessed factors associated with receipt of chemotherapy (logistic) and mortality among chemotherapy and SC users (Cox). RESULTS: Of the 4,058 patients meeting the inclusion criteria, 43 % received chemotherapy; 57 % received SC only. Among patients receiving chemotherapy, 69.1 % died within 1 year; median survival was 7.0 months. Among patients receiving only SC, 95.0 % died within 1 year; median survival was 1.5 months. The most significant factors associated with receipt of chemotherapy were patient age [odds ratio (OR) = 0.420 among patients 75-84 years and 0.099 among patients 85+ years, compared with patients aged 65-74 years) and Charlson Comorbidity Index (CCI) score (OR = 0.614 for patients with a CCI = 2 or 3 and 0.707 for patients with a CCI >3, compared with patients with a CCI = 0) (all P < 0.001). The most significant factors associated with mortality among patients receiving chemotherapy were patient age [hazard ratio (HR) = 1.321 among patients 75-84 years and 1.832 among patients 85+ years, compared with patients aged 65-74 years] and CCI score (OR = 1.287 for patients with a CCI = 2 or 3 and 1.220 for patients with a CCI >3, compared with patients with a CCI = 0) (all P < 0.01). Mean (standard deviation) all-cause healthcare costs were $96,078 ($109,072); the largest component was inpatient utilization (76.3 %). CONCLUSIONS: Younger patients with fewer comorbidities were more likely to receive chemotherapy and had longer survival. AML is associated with a substantial economic burden, and treatment outcomes appear to be suboptimal, with limited therapy options currently available.",null,"USA",2013,null,"Conventional Chemo,Supportive Care",null,"Elderly","Resource Use,Direct,Indirect","Retrospective Analysis"]
[46,"Michallet, M., et al. (2013). \"Prospective study of erythropoietin use on quality of life and cost effectiveness in acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation patients.\" Cancer 119(1): 107-114.",null,"Michallet, M., et al.","Prospective study of erythropoietin use on quality of life and cost effectiveness in acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation patients","BACKGROUND: Despite frequent anemia and multiple transfusions in patients undergoing chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia , recommendations for use of erythropoiesis-stimulating agents (ESAs) in these populations are still missing. The primary objective was the effect of ESA administration on patient's quality of life (QoL). Secondary objectives were hemoglobin (Hb) recovery, red blood cell (RBC) transfusions, overall survival, and event-free survival. METHODS: Adult patients with Hb </= 11 g/dL after consolidation chemotherapy for acute myeloid leukemia (group 1), or after allo-HSCT for any hematological diseases (group 2), were prospectively included. ESA was administered subcutaneously once per week during a maximum period of 6 months and was stopped when Hb level reached 12 g/dL. A paired-matched analysis using a historical control group was performed for secondary endpoints. Fifty-two patients were included in group 1, and 55 patients were in group 2. RESULTS: For the global population, a significant improvement of QoL was noticed with ESA use; 83% (group 1) and 71% (group 2) of patients achieved an Hb level >/= 12 g/dL without transfusion requirement. The pair-matched analysis showed a reduction of 4 RBC units per patient in group 1 (P = .0002) and 3 RBC units per patient in group 2 (P = .04). No significant difference in terms of thromboembolic events, overall survival, and event-free survival was observed between ESA and control groups. A RBC transfusion median savings of euro1712 per patient was estimated in each group. CONCLUSIONS: ESAs have a clinical and economic benefit on Hb recovery, could improve a patient's QoL, and lead to a significant reduction in number of RBC transfusions with no effect on survival.",null,"France",2013,null,"CSF",null,"Adults","Direct","Cohort Study"]
[47,"Mishra, V., et al. (2001). \"A prospective cost evaluation related to allogeneic haemopoietic stem cell transplantation including pretransplant procedures, transplantation and 1 year follow-up procedures.\" Bone Marrow Transplant 28(12): 1111-1116.",null,"Mishra, V., et al.","A prospective cost evaluation related to allogeneic haemopoietic stem cell transplantation including pretransplant procedures, transplantation and 1 year follow-up procedures","The Norwegian Ministry of Health and Social Affairs recently introduced activity-based financing for hospitals partly based on diagnosis-related groups (DRG). We soon observed that there seemed to be a considerable discrepancy between the reimbursement amount and the real cost of allogeneic haemopoietic stem cell transplantation. It was therefore decided to undertake a prospective micro-cost analysis to define a more realistic reimbursement. To identify real costs, we undertook a registration of pre-transplant procedures, transplantation and 1 year follow-up costs, including harvesting, personnel costs, clinical and laboratory procedures, together with blood products and drugs related to patients and donors. These data were compared to hospital DRG reimbursement. This information was registered for 17 consecutive patients, with a mean age 40 years (range 17-58 years). Ten patients had chronic myeloid leukaemia, three had acute lymphatic leukaemia, two had acute myeloid leukaemia and two had myelodysplastic syndrome. The data analysis showed a mean cost of US$ 106825 (NOK 901982), (range US$ 42376-362430). The average actual hospital revenue (50% DRG reimbursement + income related to length of stay + special procedure funding) was US$ 36404 (range US$ 26228-55998). Activity-based financing as applied in Norway, under-compensates hospital costs for allogeneic bone marrow transplantation. The government should make realistic estimates of real costs before introducing financial reforms in the health care system.",null,"Norway",2001,null,"Stem Cell Therapy",null,"General","Direct","Cohort Study"]
[48,"Ngamkiatphaisan, S., et al. (2007). \"Cost analysis of hematopoietic stem cell transplantation in adult patients with acute myeloid leukemia at King Chulalongkorn Memorial Hospital.\" J Med Assoc Thai 90(12): 2565-2573.",null,"Ngamkiatphaisan, S., et al.","Cost analysis of hematopoietic stem cell transplantation in adult patients with acute myeloid leukemia at King Chulalongkorn Memorial Hospital","The purpose of the study was to analyze the first-year cost ofhematopoietic stem cell transplantation (HSCT) program for the treatment of adult patients with acute myeloid leukemia (AML) at King Chulalongkorn Memorial Hospital (KCMH). The present retrospective study was carried out on 67 AML patients treated with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) at KCMH during the period of 1994 to 2005. The actual total one-year cost from the provider perspective were determined by the reviewing medical records for medical care costs (MCCs) and by adjusting data from the reports of annual cost analysis of KCMH for routine services costs (RSCs). All costs were converted to 2006 values using the Thai consumer price indices. It was found that the full cost of allogeneic HSCT (allo-HSCT) and autologous HSCT (auto-HSCT) in the first year of the program was $22,592.85 and $24,171.25 per case respectively. Cost-effective appraisal, comparing with chemotherapy, need to be studied further.",null,"Thailand",2007,null,"Stem Cell Therapy",null,"Adults","Direct","Retrospective Analysis"]
[49,"Pashko, S., et al. (1991). \"The cost-effectiveness of idarubicin/cytosine arabinoside versus daunorubicin/cytosine arabinoside in the treatment of adults with acute myeloid leukemia.\" Clin Ther 13(3): 353-360.",null,"Pashko, S., et al.","The cost-effectiveness of idarubicin/cytosine arabinoside versus daunorubicin/cytosine arabinoside in the treatment of adults with acute myeloid leukemia","The cost-effectiveness of two chemotherapeutic regimens was evaluated from the results of a randomized clinical trial involving patients with previously untreated acute myeloid leukemia. The evaluable subjects were 120 patients with acute myeloid leukemia randomly assigned to receive 12 mg/m2 of idarubicin (IDA) or 50 mg/m2 of daunorubicin (DNR) daily for three days. The patients also received 200 mg/m2 of cytosine arabinoside daily for five days, with an additional 25-mg/m2 bolus on the first day of treatment, the patients underwent a second course at the same doses. The total hospital charges per patient were $59,687 for IDA treatment and $59,567 for DNR treatment; however, the cost per complete remission was lower in the IDA than in the DNR patients ($74,609 vs $102,115). The lower remission rate in the DNR-treated patients, and thus their need for additional care, will increase the cost differences between the two treatments. The hospital charges per year of survival were $36,395 for IDA treatment and $52,714 for DNR treatment. It is concluded that IDA is more cost-effective than DNR in the treatment of adult acute myeloid leukemia.",null,"USA",1991,null,"Conventional Chemo",null,"General","Direct","RCT"]
[50,"Phillips, M., et al. (1991). \"Acute myeloid leukaemia in childhood: the costs and benefits of intensive treatment.\" Br J Haematol 77(4): 473-477.",null,"Phillips, M., et al.","Acute myeloid leukaemia in childhood: the costs and benefits of intensive treatment","Response to treatment and resource implications were compared in two groups of children with acute myeloid leukaemia (AML) treated during consecutive periods. Event-free survival at 5 years improved from 12% (SE 3.4) during 1972-82 (group A) to 45% (SE 6.9) during 1983-87 (group B). The median time spent in hospital increased from 35 to 170 d. Allogeneic marrow transplantation was offered to all eligible children in group B. Eleven of the 53 children had a suitable donor and 10 proceeded to bone marrow transplantation (BMT). The relapse rate was lower after BMT than after chemotherapy, although not significantly so. We conclude that there has been a real improvement in prognosis for children with AML; that modern treatment requires intensive hospital resources and that these results should encourage further efforts to improve outlook and to explore treatments not involving radiation.",null,"UK",1991,null,"Stem Cell Therapy",null,"Children","Unknown","Cohort Study"]
[51,"Redaelli, A., et al. (2004). \"Economic burden of acute myeloid leukemia: a literature review.\" Cancer Treat Rev 30(3): 237-247.",null,"Redaelli, A., et al.","Economic burden of acute myeloid leukemia: a literature review","OBJECTIVE: The primary objective was to examine the economic burden associated with acute myeloid leukemia (AML), a deadly hematological malignancy. AML is the most common form of acute leukemia in adults, particularly in individuals over 60 years of age; AML also accounts for 15-20% of childhood leukemia. MATERIALS AND METHODS: A systematic review was conducted of relevant studies published in the English language. Economic analyses of AML published between 1990 and 2002 were identified from electronic data sources using broad search criteria. Additional studies were obtained by manual searches of bibliographies of articles identified in the electronic searches. Articles were screened for relevance and included if the main theme included some element of AML cost of treatment, cost drivers, or cost-effectiveness. Studies reporting only drug prices without a formal comparison or analysis were not included. RESULTS: Twenty-nine studies were included in the review. Although information was limited on the comprehensive economic burden of AML from a societal perspective, the costs appear to be split equally between direct and indirect costs. Direct costs of AML from a public payer perspective were available for a few countries such as the Netherlands, Sweden, US (Medicare), and Italy. These studies found that the key cost drivers appear to be hospitalization length of stay related to initial chemotherapy, relapse of disease, and bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT). Several cost analyses have been published comparing the different treatment strategies; however, most of them were published in the early 1990s, and their analysis revolved around cost-comparison rather than comprehensive cost-effectiveness. The published studies investigated pharmacological agents (e.g., idarubicin, daunorubicin, mitoxantrone, fludarabine and combination therapies), as well as BMT, PBSCT, and the treatment of complications. CONCLUSION: Studies addressing the economic costs and burden of AML are relatively sparse in the international literature. Possible reasons for such a lack of information appear to include the low incidence rate of AML (e.g., about 260,000 new cases were reported in 2002 in the world) and the fact that it primarily afflicts older adults >60 years of age, making broad, well-designed economic analyses a challenge for most researchers. However, due to the high cost associated with the medical procedures (e.g., BMT, PBSCT) and the aging of the world population, further research is warranted.",null,"Italy",2004,null,"Stem Cell Therapy",null,"General","Direct,Indirect,Resource Use","Systematic Review"]
[52,"Rees, J. K., et al. (1996). \"Dose intensification in acute myeloid leukaemia: greater effectiveness at lower cost. Principal report of the Medical Research Council's AML9 study. MRC Leukaemia in Adults Working Party.\" Br J Haematol 94(1): 89-98.",null,"Rees, J. K., et al.","Dose intensification in acute myeloid leukaemia: greater effectiveness at lower cost. Principal report of the Medical Research Council's AML9 study. MRC Leukaemia in Adults Working Party","Between 1984 and 1990, 972 patients aged 1-79 years with acute myeloid leukaemia (AML), from 85 British hospitals, were entered into the MRC's 9th AML trial. Patients were randomized between DAT 1 + 5 (daunorubicin for 1 d, with cytarabine and 6-thioguanine for 5 d) and DAT 3 + 10 (same dose drugs for 3 and 10 d respectively) as induction therapy. The 63% who achieved complete remission (CR) were randomized to receive two courses of DAT 2 + 7 alternating with two courses of either MAZE (m-AMSA, 5-azacytidine, etoposide) or COAP (cyclophosphamide, vincristine, cytarabine, prednisone). Finally, those still in CR were randomized to receive either 1 year of maintenance treatment with eight courses of cytarabine and thioguanine followed by four courses of COAP, or no further cytotoxic therapy. Resistance to induction therapy was less common with the DAT 3 + 10 regimen than with DAT 1 + 5 (13% v 23%; P = 0.0001) and hence, despite a 5% increase in the risk of induction death, the CR rate was higher (66% v 61%; P = 0.15). Moreover, CR was achieved more rapidly with DAT 3 + 10 (median 34 v 46 d; P < 0.0001) and thus patients required less time in hospital (mean 20 v 29 d) and less blood product support. 5-year relapse-free survival (28% v 23%; P = 0.05) and survival (23% v 18%; P < 0.05) were also better with DAT 3 + 10. Post-remission intensification of therapy with MAZE resulted in fewer relapses (66% v 74% at 5 years; P = 0.03) but patients allocated MAZE required considerably more supportive care and 14 (4.5%) died following 312 MAZE courses, whereas no deaths occurred following COAP. 5-year survival was not significantly higher with MAZE (37% v 31%). Finally, although 1 year of outpatient maintenance treatment appeared to delay, but not prevent, recurrence it did not improve 5-year survival which was non-significantly worse for those allocated maintenance treatment (41% v 44%). We conclude that the more intensive induction regimen, DAT 3 + 10, is not only more effective than DAT 1 + 5, even for older patients, but is also less expensive; intensive post-remission therapy with MAZE achieves better leukaemic control but at the cost of substantial toxicity; whereas low-level maintenance therapy confers no apparent advantage in survival as well as being inconvenient and costly.",null,"UK",1996,null,"Conventional Chemo",null,"General","Resource Use","Retrospective Analysis"]
[53,"Sajben, P., et al. (1993). \"Fluconazol plus ofloxacin in prophylaxis of infections in patients with acute leukemia: a comparative study.\" Support Care Cancer 1(4): 214-216.",null,"Sajben, P., et al.","Fluconazol plus ofloxacin in prophylaxis of infections in patients with acute leukemia: a comparative study","In a retrospective study the incidence of infections, number of afebrile days, duration of antimicrobial chemotherapy, and cost of antibacterials and antimycotics were compared in two groups of patients. One was a group of 57 patients who received no prophylaxis during induction remission therapy of acute leukemia treated in 1989-1990, the second was a group of 22 patients treated in 1991 where prophylaxis with fluconazol and ofloxacin was administered. For ethical reasons pertaining since 1991, when prophylaxis became mandatory, the study was not randomized. A decrease in the number of febrile days, the cost of antimicrobials and the duration of treatment with antibiotics and antimycotics was observed in the group receiving fluconazol and ofloxacin.",null,"Slovakia",1993,null,"Antifungal,Antibiotics",null,"General","Resource Use,Direct","Retrospective Analysis"]
[54,"Schimmer, A. D., et al. (2002). \"The autologous blood and marrow transplant long-term follow-up clinic: a model of care for following and treating survivors of autotransplant.\" Support Care Cancer 10(3): 247-252.",null,"Schimmer, A. D., et al.","The autologous blood and marrow transplant long-term follow-up clinic: a model of care for following and treating survivors of autotransplant","The number of long-term survivors of autologous blood and marrow transplantation (ABMT) is increasing, but little is known about the models of care used to follow these patients. Such information would help in comparison of different methods of follow-up and allow other centers to create programs to follow their survivors. Here we describe a multidisciplinary long-term follow-up clinic for survivors of ABMT and report patient satisfaction with the clinic and economic analysis 1.5 years after its inception. In its first 1.5 years of operation, 83 new patients were seen in the clinic. Patients were evaluated a median of 4.0 years after ABMT (range 4.9 months to 12 years) and were a median of 48.5 years (range 22.5-69.0 years) old. Patients received their ABMT for non-Hodgkin's lymphoma ( n=26), Hodgkin's disease ( n=18), acute myeloid leukemia ( n=18), multiple myeloma ( n=15), breast cancer ( n=5), or desmoplastic round-cell tumor ( n=1). Patient satisfaction was assessed 1.5 years after the establishment of the long-term follow-up clinic by means of a self-report questionnaire. Seventy-five percent of patients returned the survey. Waiting times in the clinic were short, with 70% of patients seen within 30 minutes of arrival. Overall, patients were very satisfied with the new clinic model, with 85% patients reporting that the clinic met their expectations. An economic analysis indicated that the estimated annual cost of operating the clinic was approximately $53,000, which translates into $440 per patient visit, $962 per new patient or $172 per patient visit with the clinic operating at peak capacity. In conclusion, we present an inexpensive model of care for ABMT survivors that can be extended to adult survivors of malignancy not treated by ABMT.",null,"Canada",2002,null,"Stem Cell Therapy",null,"General","Resource Use","Cohort Study"]
[55,"Sornsuvit, C., et al. (2008). \"Pilot Study: effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy-induced side-effects in acute myeloid leukaemia patients.\" J Int Med Res 36(6): 1383-1391.",null,"Sornsuvit, C., et al.","Pilot Study: effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy-induced side-effects in acute myeloid leukaemia patients","The effect of parenteral glutamine dipeptide (Gln) supplementation on neutrophil phagocytosis, superoxide anion generation (SAG), prevention of chemotherapy-induced side-effects and cost-effectiveness was examined in a pilot study of acute myeloid leukaemia (AML) patients receiving chemotherapy. Sixteen AML patients were randomized to receive intravenous supplementation with Gln (30 g/day) or an equivalent quantity (25 g/day) of a standard amino acid mixture (control) on days 1 - 5 of chemotherapy. Complete blood count was evaluated twice a week until hospital discharge, and neutrophil phagocytosis and SAG were measured when absolute neutrophil count reached > 500 /microl. Patients were observed for development of infection, mucositis and diarrhoea. In Gln-treated patients, the percentage of neutrophil phagocytosis and the SAG levels were significantly higher than in control patients (20.5 +/- 6.0% and 18.9 +/- 2.9 nmol/10(6) neutrophils per 10 min, respectively). The Gln-treated patients lost significantly less weight, tended to have shorter in-patient duration and had less severe oral mucositis than controls. This pilot study provides preliminary indication that parenteral Gln supplementation enhances neutrophil phagocytic function, maintains nutritional status and is cost effective. Parenteral Gln may also prevent oral mucositis, although further studies involving more patients need to be undertaken to confirm this and the other results.",null,"Thailand",2008,null,"Supportive Care",null,"General","Resource Use","Cohort Study"]
[56,"Stalfelt, A. M. and H. Brodin (1994). \"Costs over time in conventional treatment of acute myeloid leukaemia. A study exploring changes in treatment strategies over two decades.\" J Intern Med 236(4): 401-409.",null,"Stalfelt, A. M. and H. Brodin","Costs over time in conventional treatment of acute myeloid leukaemia. A study exploring changes in treatment strategies over two decades","OBJECTIVES: The aim was to analyse the consumption of different items in conventional treatment of acute myeloid leukaemia (AML) and their cost, in order to evaluate the economic consequences of new treatment strategies. DESIGN: Data on items of treatment were gathered retrospectively from case notes, including amount and date. Prices were gathered from price lists made up for internal billing/accounting. SETTING: The patients were all treated in a hospital with excellent treatment and service facilities. SUBJECTS: Seventy-three AML patients treated from 1973 to 1980, all since deceased, were compared with 54 patients treated from 1981 to 1988, of whom 14 were alive at the end of the observation period. INTERVENTIONS: The patients were treated according to randomized treatment protocols to achieve complete remission. Maintenance treatment or consolidation courses were given. In relapse, new induction treatment was given. MAIN OUTCOME MEASURES: Complete remission and survival were registered. The costs were divided into basic hospital costs and patient-specific costs. RESULTS: The mean total treatment cost for an AML patient in the 1970s was 211,138 SEK, and in 1980s 356,911 SEK. (UK 1 pound = 10.57 SEK, US$1 = 5.91 SEK 1990). All treatment costs increased between the periods: hospital costs by 20%, and patient-specific costs by 186%. Antibiotics, cytostatics and outpatient department costs had increased the most. The mean survival time almost doubled, and in the 1980s group there were several long-term survivors. CONCLUSIONS: The costs for AML treatment increased considerably from the 1970s to the 1980s. The effectiveness of these treatments increased as well, resulting in increased rate and duration of survival, and several patients were long-term survivors. It was not possible to identify the cost consequences of separate new technologies.",null,"Sweden",1994,null,"Unknown",null,"General","Resource Use,Direct,Indirect","Retrospective Review"]
[57,"Stalfelt, A. M., et al. (1994). \"Cost analysis of different phases of acute myeloid leukaemia.\" Leuk Res 18(10): 783-790.",null,"Stalfelt, A. M., et al.","Cost analysis of different phases of acute myeloid leukaemia","Priority lists have been formulated in several countries and cut-backs can be a threat to leukaemia treatment. We analysed the costs in different phases of disease for 54 conventionally treated patients with acute myeloid leukaemia. Thirty-two patients reached CR 1, seven patients are still alive as of May 1994. We found a cost per week and patient of 17,334 Swedish Crowns (SEK) (U.K. 1 pound = 10.57 and U.S. $1 = 5.91, 1990) in induction phase, 1854 in remission phase and 10,529 SEK in relapse phase. In the terminal phase 10% of the total cost was spent. The quality of life of the patients in relapse is discussed and palliative treatment is emphasized.",null,"Sweden",1994,null,"Unknown",null,"General","Direct","Retrospective Analysis"]
[58,"Stam, W. B., et al. (2008). \"Economic evaluation of posaconazole vs. standard azole prophylaxis in high risk neutropenic patients in the Netherlands.\" Eur J Haematol 81(6): 467-474.",null,"Stam, W. B., et al.","Economic evaluation of posaconazole vs. standard azole prophylaxis in high risk neutropenic patients in the Netherlands","BACKGROUND: Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients experience prolonged neutropenia after treatment with intensive chemotherapy, leading to a high risk of invasive fungal infections (IFI). The present study evaluates the cost effectiveness of posaconazole vs. standard azoles for the prevention of IFIs in neutropenic patients in the Netherlands. METHODS: A decision-tree model was developed using data from a randomized trial that compared posaconazole and standard azole (fluconazole or itraconazole) prophylaxis in neutropenic patients receiving remission-induction chemotherapy for AML/MDS (Cornely et al., N Engl J Med 2007;356:348-359). Following initiation of prophylaxis, clinical events are modeled with chance nodes reflecting probabilities of IFIs, IFI-related death, and death from other causes. Patients surviving the prophylaxis are assumed to have a life expectancy according to the underlying condition. This allows translation of the trial outcomes to a lifetime horizon. Data on life expectancy, quality of life, medical resource consumption and costs were obtained from the literature. Model outcomes include cost per life year (LY) gained and cost per quality adjusted life year (QALY) gained. RESULTS: The total cost (treatment of breakthrough IFI + prophylaxis) for posaconazole amounted to 4412 euros (95% uncertainty interval 3403 euros - 5666 euros), which is -183 euros (-1985 euros to 1564 euros) less than costs with standard azoles. Posaconazole prophylaxis resulted in 0.08 (0.02-0.15) QALYs gained in comparison with prophylaxis with standard azoles. Results from a probabilistic sensitivity analysis indicate that there is a 90% probability that the cost per QALY gained with posaconazole is below 20,000 euros. Additional scenario analyzes with different assumptions confirmed these findings. CONCLUSION: Given the underlying data and assumptions, the economic evaluation demonstrated that posaconazole prophylaxis is expected to be cost-effective compared with fluconazole/itraconazole in neutropenic AML/MDS patients after intensive chemotherapy.",null,"The Netherlands",2008,null,"Antifungal,Conventional Chemo",null,"General","Resource Use,Direct","RCT"]
[59,"Standaert, B., et al. (2002). \"Economic analysis of filgrastim use for patients with acute myeloid leukaemia in the UK: a comparison of collection methods of resource use data.\" Pharmacoeconomics 20(10): 665-674.",null,"Standaert, B., et al.","Economic analysis of filgrastim use for patients with acute myeloid leukaemia in the UK: a comparison of collection methods of resource use data","BACKGROUND: A clinical trial of patients with de novo acute myeloid leukaemia (AML) showed that haematopoietic support with filgrastim (granulocyte colony-stimulating factor, G-CSF) following induction and consolidation chemotherapy accelerated recovery from neutropenia. The clinical benefits included reductions in infections, anti-infective therapy and length of hospital stay. OBJECTIVE: The objective of this economic analysis is 2-fold. First, it aims to determine if the observed clinical benefits from the use of filgrastim would lead to cost savings from the perspective of a healthcare institution in the UK. Second, the analysis compares the results of two methods on collection of resource use data. DESIGN: A retrospective cost-minimisation analysis was undertaken based on the clinical results of all UK patients enrolled in the trial. Two cost models were developed: a model based only on the medical resource use collected in the case report forms (the CRF model); and a model based on all medical resources collected from patient medical files (the PF Model). Treatment costs of AML between filgrastim and the placebo arm were compared for the first induction cycle as well as the first induction and the first consolidation cycles combined. Results from the two models were compared. SETTING AND PATIENTS: The CRF model was applied to two samples of patients: all UK patients (n = 82) and patients enrolled at one centre [the Manchester Royal Infirmary (MRI) (n = 30)], whereas the PF model was applied to the MRI patient sample only. RESULTS: For all UK patients, using the CRF model, the filgrastim-treated arm produced cost savings of 747 pounds sterling (9.0%) and 2135 pounds sterling (14.4%) [1998 values] per patient in the first induction cycle and in the induction and consolidation cycles combined, respectively. For the patients at MRI the CRF model resulted in cost savings with filgrastim of 177 pounds sterling (2.2%) and 414 pounds sterling (3.2%) per patient respectively. Using the PF model the savings at MRI were 910 pounds sterling (8.6%) and 1285 pounds sterling (8.0%) per patient, respectively. CONCLUSION: Use of filgrastim in the treatment of AML in the UK may result in net cost savings. A retrospective analysis using total resources obtained through patient files produced higher cost savings estimates than that obtained by resources noted in the CRFs. The models based on PF resource data may be more reliable because they are more comprehensive. However, the cost estimates in this study may have been impacted by sample size, site characteristics, disease and treatment settings. Therefore, further evaluation on the methods for collecting resource use data in larger, multicentred studies is warranted.",null,"USA",2002,null,"CSF",null,"General","Resource Use,Direct","Retrospective Analysis"]
[60,"Sung, A. H., et al. (2015). \"An update to the cost-effectiveness of posaconazole vs fluconazole or itraconazole in the prevention of invasive fungal disease among neutropenic patients in the United States.\" J Med Econ 18(5): 341-348.",null,"Sung, A. H., et al.","An update to the cost-effectiveness of posaconazole vs fluconazole or itraconazole in the prevention of invasive fungal disease among neutropenic patients in the United States","OBJECTIVES: Posaconazole has shown superior clinical efficacy in the prevention of invasive fungal disease (IFD) among neutropenic patients as well as cost-effectiveness in the US healthcare setting vs fluconazole or itraconazole (FLU/ITRA) based on oral suspension formulations of each therapy. This study aims to provide an update on the cost-effectiveness of posaconazole in the current US healthcare setting to reflect bioequivalent tablet formulations of posaconazole and fluconazole, as well as changes in healthcare and drug costs. METHODS: An existing model was used to assess the cost-effectiveness of posaconazole vs FLU/ITRA in the prevention of IFD among patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) and chemotherapy-induced neutropenia. Drug efficacy, mortality related to IFD, and death from other causes were estimated for tablet formulations using data from a randomized clinical trial of oral suspensions based on bioequivalence. IFD treatment costs were updated using the average inflation rate over 8 years (2006-2014) and drug costs were based on 2014 Analysource data. RESULTS: Trial data show a lower IFD probability over 100 days of follow-up with posaconazole compared to standard azole therapy (0.05 vs 0.11). The treatment duration on posaconazole is 29 days compared to 24 days for FLU and 29 days for ITRA. The average cost of prophylaxis is higher in the posaconazole group compared to FLU/ITRA ($4673 vs $353); however, the costs associated with treating the IFD are lower in the posaconazole group compared to FLU/ITRA ($2205 vs $5303). The incremental cost effectiveness ratio of IFD avoided for posaconazole is $18,898 vs FLU/ITRA. CONCLUSIONS: In the current healthcare cost environment where both drug costs and overall IFD treatment costs have increased since 2007, posaconazole tablets are a cost-effective alternative to fluconazole or itraconazole in the prevention of IFD among neutropenic patients with AML and MDS in the US.",null,"USA",2015,null,"Antifungal",null,"General","Direct","RCT"]
[61,"Takeshita, A., et al. (1995). \"Significant reduction of medical costs by differentiation therapy with all-trans retinoic acid during remission induction of newly diagnosed patients with acute promyelocytic leukemia. The Japan Adult Leukemia Study Group.\" Cancer 76(4): 602-608.",null,"Takeshita, A., et al.","Significant reduction of medical costs by differentiation therapy with all-trans retinoic acid during remission induction of newly diagnosed patients with acute promyelocytic leukemia. The Japan Adult Leukemia Study Group","BACKGROUND: Differentiation therapy with all-trans retinoic acid (RA) induces more than 80% complete remission with the least complications in patients with acute promyelocytic leukemia (APL). The authors studied the cost-benefit of this new treatment modality compared with conventional chemotherapy in newly diagnosed patients with APL. METHODS: Costs were calculated retrospectively through the monthly bills of each patient to national health insurance and were compared between 36 patients treated with conventional chemotherapy in the AML-87 or AML-89 studies and 40 patients treated with all-trans RA alone or with all-trans RA plus low dose chemotherapy in the AML-92 study of the Japan Adult Leukemia Study Group who were treated at 22 university and cancer hospitals in Japan. RESULTS: Average medical costs except for antileukemic drugs during 2 months after admission were 4,164,026 yen (approximately US$46,300) in the chemotherapy group and 2,906,825 yen (approximately US$32,300) in the all-trans RA group (P < 0.0001). The difference resulted mainly from the costs of antibiotics and of platelet and erythrocyte transfusions. Average costs of antibiotics were 650,494 yen (approximately US$7,200) and 349,138 yen (approximately US$3,900), respectively (P < 0.0002), and those of platelet and erythrocyte transfusions were 1,016,190 yen (approximately US$11,300) and 633,444 yen (approximately US$7,000), respectively (P < 0.0020). CONCLUSION: During the remission induction therapy of newly diagnosed APL, all-trans RA significantly reduced medical costs. all-trans RA should be incorporated into the front-line therapy of patients with APL for medical and economic reasons.",null,"Japan",1995,null,"Various",null,"Adults","Direct","Retrospective Analysis"]
[62,"Tallman, M., et al. (2015). \"Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States.\" Clin Lymphoma Myeloma Leuk 15(12): 771-777.",null,"Tallman, M., et al.","Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States","INTRODUCTION: This study estimated the cost-effectiveness of arsenic trioxide (ATO) added to all-trans retinoic acid (ATRA) when used in first-line acute promyelocytic leukemia (APL) treatment. MATERIALS AND METHODS: A Markov cohort model was developed with 3 states: stable disease (during first- or second-line treatment), disease event, and death. Newly diagnosed patients with low- to intermediate-risk APL were included and each month could remain in their current health state or move to another. Treatment consisted of ATO + ATRA, ATRA + idarubicin (IDA), or ATRA + cytarabine (AraC) + additional chemotherapy. After an initial disease event, patients discontinued first-line therapy and switched to a second-line ATO regimen. Efficacy and safety data were obtained from published trials; quality of life/utility estimates were obtained from the literature; costs were obtained from US data sources. Costs and outcomes over time were used to calculate incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Compared to ATRA + AraC + additional chemotherapy, ATRA + IDA treatment had ICERs of $2933 per life-year (LY) saved and $3122 per quality-adjusted life-year (QALY) gained. Compared to the ATRA + IDA regimen, first-line ATO + ATRA treatment had ICERs of $4512 per LY saved and $5614 per QALY gained. Results were sensitive to changes in pharmacy costs of the ATO + ATRA regimen during consolidation. CONCLUSION: The ATO + ATRA regimen is highly cost-effective compared to ATRA + AraC + additional chemotherapy or ATRA + IDA in the treatment of newly diagnosed low- to intermediate-risk APL patients.",null,"UK",2015,null,"Various",null,"General","Direct","Retrospective Analysis"]
[63,"Tennvall, G. R., et al. (1994). \"The economic costs of acute myeloid leukemia in Sweden.\" Int J Technol Assess Health Care 10(4): 683-694.",null,"Tennvall, G. R., et al.","The economic costs of acute myeloid leukemia in Sweden","The direct and indirect costs of acute myeloid leukemia were estimated for Sweden in 1989. The calculated total cost was SEK 460 million. Nearly half of the costs, or 1.7 million per patient diagnosed, were indirect costs due to premature mortality. Direct costs of relapses and indirect costs of mortality represent costs due to the absence of completely curable therapy. They also represent potential cost savings that could be obtained after introduction of new treatment options in the future.",null,"Sweden",1994,null,"Unknown",null,"Unknown","Direct,Indirect","Unknown"]
[64,"Thomas, X., et al. (2007). \"Autologous stem cell transplantation after complete remission and first consolidation in acute myeloid leukemia patients aged 61-70 years: results of the prospective EORTC-GIMEMA AML-13 study.\" Haematologica 92(3): 389-396.",null,"Thomas, X., et al.","Autologous stem cell transplantation after complete remission and first consolidation in acute myeloid leukemia patients aged 61-70 years: results of the prospective EORTC-GIMEMA AML-13 study","BACKGROUND AND OBJECTIVES: The optimal post-remission treatment for elderly patients with acute myeloid leukemia (AML) is presently unknown. Recent studies have reported the feasibility of autologous peripheral blood stem cell transplantation (PBSCT) in this population. We evaluate the outcome of this post-remission approach after complete remission (CR) and consolidation in elderly patients included in the EORTC-GIMEMA AML-13 trial. DESIGN AND METHODS: PBSCT after induction and consolidation chemotherapy was evaluated in patients aged 61 to 70 years with a WHO performance status 0-1. The induction therapy was mitoxantrone, etoposide and cytarabine (MICE) with or without granulocyte colony-stimulating factor (G-CSF) during and/or after chemotherapy. The consolidation therapy consisted of non-infusion or infusional idarubicin, etposide and cytarabine (mini-ICE). RESULTS: Sixty-one patients were scheduled for stem cell harvest by leukapheresis after s.c. recombinant human G-CSF administration initiated after hematopoietic recovery from consolidation. Stem cells were effectively harvested from 54 patients. A median of two aphereses (range, 1-5) were performed, resulting in a median collection of 11.7 x 10(8) nucleated cells/kg (range, 2.4-99.8) containing 40.2 x 10(4) CFU-GM/kg (range, 0-786.8), and 5 x 10(6) CD34+ cells/kg (range, 0.1-99.8). For the whole group of 61 patients, the median disease-free survival (DFS) was 1.0 years and the 3-year DFS rate was 21%, while the median overall survival (OS) was 1.4 years and the 3-year OS rate was 32%. A total of 26 patients could not be autografed due to inadequate/no harvest (21 patients), early relapse (3 patients), or treatment refusal (2 patients). Autologous transplantation was performed in 35 patients following conditioning with the BAVC regimen. The median time for granulocyte recovery >0.5 109 yen/L was 24 days and for platelets >20 x10(9)/L was 23 days following transplantation. After a median follow-up of 5.0 years from transplantation, the median DFS and OS were 1.1 and 1.6 years respectively, and the 3-year rates were 28% and 39% respectively. Eight autografted patients were still in continuous complete remission, 22 patients had relapsed and five had died in CR. INTERPRETATION AND CONCLUSIONS: Intensification of remission including autologous PBSCT is feasible in about half of harvested patients aged 61 to 70 years old, and did not improve the general outcome. This shows the limitations of autologous PBSCT and other intensive treatment modalities in elderly AML patients. Key words: acute myeloid leukemia, elderly, autologous stem cell transplantation.",null,"France",2007,null,"Stem Cell Therapy",null,"Elderly","Resource Use","Clinical trial"]
[65,"Uyl-de Groot, C. A., et al. (2001). \"Costs of diagnosis, treatment, and follow up of patients with acute myeloid leukemia in the netherlands.\" J Hematother Stem Cell Res 10(1): 187-192.",null,"Uyl-de Groot, C. A., et al.","Costs of diagnosis, treatment, and follow up of patients with acute myeloid leukemia in the netherlands","The aim of the study was to calculate the costs in various places of acute myeloid leukemia (AML). Patients less than 65 years old, who were treated for newly diagnosed AML were included. The cost analysis distinguished between diagnosis, treatment, follow-up (maximum of 2 years), and treatment of relapse. The treatment period was divided into remission induction and consolidation treatment, harvest of bone marrow (BM) or peripheral blood stem cells, and transplantation. The costs of diagnosis amounted to $3,167 (1995 US$). Remission-induction treatments cost on average $46,387 and harvest of bone marrow or peripheral blood stem cells costs $6,491. The costs of the transplantation varied between $25,531 and $44,087. Costs of follow-up amounted to $4,167. Relapse treatment, mainly consisting of reinduction therapy, costs on average $24,338. The total average weighted costs of AML patients amounted to $104,386. Treating AML patients is very expensive, and major reductions in costs are not expected in the next future. Considering efficacy and effectiveness, it seemed that choices based on costs could be made between several consolidation techniques and between a specific consolidation technique and/or palliative treatment.",null,"The Netherlands",2001,null,"Unknown",null,"General","Direct","Retrospective Analysis"]
[66,"Uyl-de Groot, C. A., et al. (1996). \"Colony-stimulating factors and peripheral blood progenitor cell transplantation. Benefits and costs.\" Pharmacoeconomics 10(1): 23-35.",null,"Uyl-de Groot, C. A., et al.","Colony-stimulating factors and peripheral blood progenitor cell transplantation. Benefits and costs","High dosage chemo- or radiotherapy followed by the administration of autologous bone marrow-derived stem cells [i.e. autologous bone marrow transplantation (ABMT)] is an established protocol for treating acute myeloid leukaemia and malignant lymphoma. The approach is also under investigation in the treatment of acute lymphocytic leukaemia, multiple myeloma and solid tumours. In all of these diseases, the optimisation of indications, conditioning schemes, stem cell harvest techniques and supportive care with growth factors is subject to continuous preclinical research and clinical phase II and III studies. Recently, the administration of peripheral blood stem cell preparations to cancer patients as rescue therapy after high dosage antitumour therapy has been received with much enthusiasm. At first glance, the technique looks rather easy to perform. The faster recovery of haemopoiesis, compared with ABMT, leads to shorter durations of hospitalisation. Moreover, in most studies, peripheral blood progenitor cell transplantation (PBPCT) resulted in fewer septic episodes, fewer intensive care admissions, fewer red blood cell and platelet transfusions, reduced use of anti-infectives and parenteral nutrition, and reduced hospital costs compared with ABMT. The overall conclusion is that the treatment costs of PBPCT are 15 to 30% lower than the treatment costs of ABMT. However, a formal comparison between PBPCT and ABMT, assessing the differences in toxicity, costs and quality of life, is still awaited.",null,"The Netherlands",1996,null,"Stem Cell Therapy",null,"Unknown","Direct","Narrative Review"]
[67,"Uyl-de Groot, C. A., et al. (1998). \"Cost-effectiveness and quality-of-life assessment of GM-CSF as an adjunct to intensive remission induction chemotherapy in elderly patients with acute myeloid leukemia.\" Br J Haematol 100(4): 629-636.",null,"Uyl-de Groot, C. A., et al.","Cost-effectiveness and quality-of-life assessment of GM-CSF as an adjunct to intensive remission induction chemotherapy in elderly patients with acute myeloid leukemia","We conducted a prospective, randomized, multicentre clinical trial comparing the effects and costs of GM-CSF as an adjunct to intensive chemotherapy in elderly patients with acute myeloid leukaemia (AML). The patients were randomized to either daunomycin-cytosine arabinoside (control arm: n = 161) or daunomycin-cytosine arabinoside with GM-CSF (GM-CSF arm: n = 157). The primary end-point was the effect of GM-CSF on the percentage of complete remissions (CR). Survival duration, disease-free survival, quality of life and costs were evaluated separately. CR after remission induction treatment was achieved in 55% of the patients in the control group and in 56% of the patients in the GM-CSF group (P = NS). The duration of survival and disease-free survival at 2 years after randomization were estimated at 22% and 19% for the control group and 22% and 14% for the GM-CSF group (P = NS). Considering the short-term quality of life, the administration of GM-CSF resulted in more problems with regard to depressed mood, diarrhoea and rash/eczema. With regard to the long-term quality of life there were no significant differences between the two groups. The average costs of the primary treatment were higher in GM-CSF-treated patients than in the control group, i.e. US$40782 and US$34465, respectively (P < 0.01). The costs during the follow-up period did not differ between the two groups. The results of this randomized clinical trial indicate that daunomycin-cytosine arabinoside plus GM-CSF is not a cost-effective treatment strategy when compared with daunomycin-cytosine arabinoside alone.",null,"The Netherlands",1998,null,"CSF,Conventional Chemo",null,"Elderly","Direct","RCT"]
[68,"Uyl-de Groot, C. A., et al. (1995). \"Costs of introducing autologous BMT in the treatment of lymphoma and acute leukaemia in The Netherlands.\" Bone Marrow Transplant 15(4): 605-610.",null,"Uyl-de Groot, C. A., et al.","Costs of introducing autologous BMT in the treatment of lymphoma and acute leukaemia in The Netherlands","In a retrospective study we calculated the costs of introducing autologous BMT in the treatment of patients with malignant lymphoma and acute leukaemia in The Netherlands. The cost analysis has been performed in five university hospitals and one cancer centre, in a series of patients with intermediate and high grade non-Hodgkin's lymphoma (NHL) and patients with AML. Conventional treatment consisted of chemotherapy. The average costs of the conventional NHL treatment varied from US$3120 to U$12,900. The costs of autologous BMT amounted to US$40,220. In the AML group the costs of conventional treatment amounted to about US$11,040, as only 50% of the patients were treated further. The costs of autologous BMT including a follow-up period of 2 years, amounted to US$55,440. In The Netherlands the total number of autologous BMTs per year in these patient groups was estimated at 230; 180 in the NHL group and 50 in the AML group. The costs of introducing autologous BMT to the NHL group will vary between 4.93 and 6.68 million dollars and for the AML group these costs were estimated at 2.22 million dollars. As a result, the total extra costs of introducing autologous BMTs are expected to be between 7.15 and 8.9 million dollars.",null,"The Netherlands",1995,null,"Stem Cell Therapy,Conventional Chemo",null,"Unknown","Direct","Retrospective Analysis"]
[69,"van Agthoven, M., et al. (2002). \"Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia.\" Bone Marrow Transplant 30(4): 243-251.",null,"van Agthoven, M., et al.","Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia","Allogeneic stem cell transplantation (SCT) is one of the most expensive medical procedures. However, only a few studies to date have addressed the costs of HLA-identical sibling transplantation and only one study has reported costs of unrelated transplantation. No recent cost analysis with a proper follow-up period and donor identification expenses is available on related or voluntary matched unrelated donor (MUD) SCT for adult AML or ALL. Therefore, we calculated direct medical (hospital) costs based on 97 adults who underwent HLA-identical sibling bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT), and patients who received a graft from a MUD between 1994 and 1999. The average costs per transplanted patient were Euro 98,334 (BMT), Euro 151,754 (MUD), and Euro 98,977 (PBSCT), including donor identification expenses, 2 years follow-up and costs of patients who were not transplanted after they had been planned to receive an allograft. The majority of these costs was generated during the hospitalisation for graft infusion. For MUD transplants, nearly one-third of these costs was spent on the search for a suitable donor. For patients who were alive after 2 years, cumulative expenses were calculated to be Euro 103,509 (BMT), Euro 173,587 (MUD), and Euro 105,906 (PBSCT).",null,"The Netherlands",2002,null,"Stem Cell Therapy",null,"General","Direct","Cohort Study"]
[70,"Van de Velde, A. L., et al. (2016). \"Medical costs of treatment and survival of patients with acute myeloid leukemia in Belgium.\" Leuk Res 46: 26-29.",null,"Van de Velde, A. L., et al.","Medical costs of treatment and survival of patients with acute myeloid leukemia in Belgium","The advent of new cell-based immunotherapies for leukemia offers treatment possibilities for certain leukemia subgroups. The wider acceptability of these new technologies in clinical practice will depend on its impact on survival and costs. Due to the small patient groups who have received it, these aspects have remained understudied. This non-randomized single-center study evaluated medical costs and survival for acute myeloid leukemia between 2005 and 2010 in 50 patients: patients treated with induction and consolidation chemotherapy (ICT) alone; patients treated with ICT plus allogeneic hematopoietic stem cell transplantation (HCT), which is the current preferred post-remission therapy in patients with intermediate- and poor-risk AML with few co-morbidities, and patients treated with ICT plus immunotherapy using autologous dendritic cells (DC) engineered to express the Wilms' tumor protein (WT1). Total costs including post- consolidation costs on medical care at the hematology ward and outpatient clinic, pharmaceutical prescriptions, intensive care ward, laboratory tests and medical imaging were analyzed. Survival was markedly better in HCT and DC. HCT and DC were more costly than ICT. The median total costs for HCT and DC were similar. These results need to be confirmed to enable more thorough cost-effectiveness analyses, based on observations from multicenter, randomized clinical trials and preferably using quality-adjusted life-years as an outcome measure.",null,"Belgium",2016,null,"Stem Cell Therapy,Conventional Chemo",null,"General","Direct,Resource use","Cohort Study"]
[71,"Vaughn, J. E., et al. (2015). \"Resource Utilization and Safety of Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia or Myelodysplastic Syndrome: A Nonrandomized Clinical Comparative Analysis.\" JAMA Oncol 1(8): 1120-1127.",null,"Vaughn, J. E., et al.","Resource Utilization and Safety of Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia or Myelodysplastic Syndrome: A Nonrandomized Clinical Comparative Analysis","IMPORTANCE: Adults with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) typically remain hospitalized after induction or salvage chemotherapy until blood cell count recovery, with resulting prolonged inpatient stays being a primary driver of health care costs. Pilot studies suggest that outpatient management following chemotherapy might be safe and could reduce costs for these patients. OBJECTIVE: To compare safety, resource utilization, infections, and costs between adults discharged early following AML or MDS induction or salvage chemotherapy and inpatient controls. DESIGN: Nonrandomized, phase 2, single-center study conducted at the University of Washington Medical Center. Over a 43-month period (January 1, 2011, through July 31, 2014), 178 adults receiving intensive AML or MDS chemotherapy were enrolled. After completion of chemotherapy, 107 patients met predesignated medical and logistical criteria for early discharge, while 29 met medical criteria only and served as inpatient controls. INTERVENTIONS: Early-discharge patients were released from the hospital at the completion of chemotherapy, and supportive care was provided in the outpatient setting until blood cell count recovery (median, 21 days; range, 2-45 days). Controls received inpatient supportive care (median, 16 days; range, 3-42 days). MAIN OUTCOMES AND MEASURES: We analyzed differences in early mortality, resource utilization including intensive care unit (ICU) days, transfusions per study day, and use of intravenous (IV) antibiotics per study day), numbers of infections, and total and inpatient charges per study day among early-discharge patients vs controls. RESULTS: Four of the 107 early-discharge patients and none of the 29 control patients died within 30 days of enrollment (P=.58). Nine early-discharge patients (8%) but no controls required ICU-level care (P=.20). No differences were noted in the median daily number of transfused red blood cell units (0.27 vs 0.29; P=.55) or number of transfused platelet units (0.26 vs 0.29; P=.31). Early-discharge patients had more positive blood cultures (37 [35%] vs 4 [14%]; P=.04) but required fewer IV antibiotic days per study day (0.48 vs 0.71; P=.01). Overall, daily charges among early-discharge patients were significantly lower than for inpatients (median, $3840 vs $5852; P<.001) despite increased charges per inpatient day when readmitted (median, $7405 vs $5852; P<.001). CONCLUSIONS AND RELEVANCE: Early discharge following intensive AML or MDS chemotherapy can reduce costs and use of IV antibiotics, but attention should be paid to complications that may occur in the outpatient setting.",null,"USA",2015,null,"Unknown",null,"Adults","Resource Use","Cohort Study"]
[72,"Walter, R. B., et al. (2011). \"Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study.\" Haematologica 96(6): 914-917.",null,"Walter, R. B., et al.","Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study","Due to infectious and bleeding risks, adults with acute myeloid leukemia or high-risk myelodysplastic syndromes typically remain hospitalized after remission induction chemotherapy until blood count recovery. Here, we explored the medical and financial effects of discharge immediately after chemotherapy completion with close outpatient follow up. Within 12 months, 15 patients fulfilling both medical and logistical criteria were discharged early, whereas 5 patients meeting medical criteria only served as inpatient controls. No patient died. Patients discharged early spent a median of 8 days (range 3-36 days), or 54% of their study time, as outpatients. These patients required less time on intravenous antibiotics (6 vs. 16 days; P=0.11), received fewer red blood cell transfusions (0.25 vs. 0.48 units/day; P=0.08), and incurred lower median daily charges ($3,270 vs. $5,467; P=0.01) than controls. Thus, early discharge of selected patients appears, safe and may reduce cost and resource utilization. (ClinicalTrials.gov Identifier: NCT00844441).",null,"USA",2011,null,"Unknown",null,"General","Resource Use","Clinical trial"]
[73,"Wang, H. I., et al. (2014). \"Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model.\" Value Health 17(2): 205-214.",null,"Wang, H. I., et al.","Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model","BACKGROUND: Acute myeloid leukemia (AML) can be diagnosed at any age and treatment, which can be given with supportive and/or curative intent, is considered expensive compared with that for other cancers. Despite this, no long-term predictive models have been developed for AML, mainly because of the complexities associated with this disease. OBJECTIVE: The objective of the current study was to develop a model (based on a UK cohort) to predict cost and life expectancy at a population level. METHODS: The model developed in this study combined a decision tree with several Markov models to reflect the complexity of the prognostic factors and treatments of AML. The model was simulated with a cycle length of 1 month for a time period of 5 years and further simulated until age 100 years or death. Results were compared for two age groups and five different initial treatment intents and responses. Transition probabilities, life expectancies, and costs were derived from a UK population-based specialist registry-the Haematological Malignancy Research Network (www.hmrn.org). RESULTS: Overall, expected 5-year medical costs and life expectancy ranged from pound8,170 to pound81,636 and 3.03 to 34.74 months, respectively. The economic and health outcomes varied with initial treatment intent, age at diagnosis, trial participation, and study time horizon. The model was validated by using face, internal, and external validation methods. The results show that the model captured more than 90% of the empirical costs, and it demonstrated good fit with the empirical overall survival. CONCLUSIONS: Costs and life expectancy of AML varied with patient characteristics and initial treatment intent. The robust AML model developed in this study could be used to evaluate new diagnostic tools/treatments, as well as enable policy makers to make informed decisions.",null,"Norway,UK",2014,null,"Unknown",null,"General","Direct","Cohort Study"]
[74,"Weiman, M. G. (1995). \"Case management. A means to improve quality and control the costs of cure in children with acute myelogenous leukemia.\" J Pediatr Hematol Oncol 17(3): 248-253.",null,"Weiman, M. G.","Case management. A means to improve quality and control the costs of cure in children with acute myelogenous leukemia","Acute myelogenous leukemia (AML) is a costly disease to treat, as patients experience many hospital stays secondary to chemotherapy, the side effects of treatment, and bone marrow transplantation. The trend for some medical centers has been to reduce costs and increase quality through case management. The case manager uses critical pathways and one-on-one interaction to facilitate the patients' progress through the hospital system and to decrease delays and duplication. CONCLUSION: Case management and critical pathways could become an indispensable tool for the management of pediatric patients with cancer.",null,"USA",1995,null,"Conventional Chemo",null,"Unknown","Unknown","Unknown"]
[75,"Wheatley, K., et al. (2009). \"Randomized placebo-controlled trial of granulocyte colony stimulating factor (G-CSF) as supportive care after induction chemotherapy in adult patients with acute myeloid leukaemia: a study of the United Kingdom Medical Research Council Adult Leukaemia Working Party.\" Br J Haematol 146(1): 54-63.",null,"Wheatley, K., et al.","Randomized placebo-controlled trial of granulocyte colony stimulating factor (G-CSF) as supportive care after induction chemotherapy in adult patients with acute myeloid leukaemia: a study of the United Kingdom Medical Research Council Adult Leukaemia Working Party","The role of granulocyte colony stimulating factor (G-CSF) as supportive therapy following intensive induction chemotherapy for acute myeloid leukaemia (AML) in adults was investigated in a randomized trial. G-CSF (Lenograstim, 263 microg/d) or placebo was administered from day 8 after the end of chemotherapy until neutrophil recovery to 0.5 x 10(9)/l (or for up to 10 d). Eight hundred and three patients were entered. Neutrophil recovery was quicker with G-CSF (P < 0.0001), but this did not lead to differences in the number, severity or duration of infections. There were no substantial supportive care savings, although G-CSF patients spent 2 d less in hospital (P = 0.01). Complete remission (CR) rates were similar between arms (73% G-CSF, 75% placebo, P = 0.5), as were reasons for failure (induction death: P = 0.7; resistant disease: P = 0.5) and, for remitters, 5-year disease-free survival (34% vs. 38%, P = 0.3). Overall survival at 5 years was 29% with G-CSF vs. 36% with placebo (P = 0.10). Both CR rate (P = 0.006) and overall survival (P = 0.006) were worse with G-CSF in patients aged <40 years, but this may be a chance effect. There is some evidence from this trial of an adverse effect of G-CSF but these data need to be viewed in the context of the evidence from the other trials.",null,"UK",2009,null,"CSF",null,"Adults","Resource Use","RCT"]
[76,"Whittington, R. and K. L. Goa (1993). \"Idarubicin: a pharmacoeconomic evaluation of its use in adult patients with acute myeloid leukaemia.\" Pharmacoeconomics 4(4): 287-307.",null,"Whittington, R. and K. L. Goa","Idarubicin: a pharmacoeconomic evaluation of its use in adult patients with acute myeloid leukaemia","Idarubicin is an effective agent in the treatment of acute myeloid leukaemia (AML), inducing complete remission in 39 to 80% of newly diagnosed patients. Although it also demonstrates efficacy as monotherapy, and is of use in relapsed or refractory disease, most comparative clinical trials have administered idarubicin intravenously in combination with cytarabine in newly diagnosed patients. These trials indicate that improved survival and response rates, and rapid achievement of remission, are more likely with idarubicin than with daunorubicin, when both agents are given in combination with cytarabine. In elderly patients, however, response rates are lower than in younger patients, and there is less disparity in efficacy between idarubicin and daunorubicin induction therapy. Although AML is an expensive disease to treat, the majority of costs are associated with the length of hospitalisation, with the acquisition cost of the chemotherapy agents contributing less than 10% to overall expenditure. Idarubicin combined with cytarabine therapy achieved higher response rates with the first cycle of therapy than daunorubicin, thereby reducing the requirements for a second cycle of therapy and further hospitalisation. Compared with daunorubicin plus cytarabine induction treatment, idarubicin plus cytarabine reduced the costs of achieving a complete response by between 22 and 39% in patients with a median age less than 60 years. In patients with a median age of 62 years, who are more representative of the AML population, costs of achieving a complete response were reduced by 3 to 6%. Thus, idarubicin is more cost effective than daunorubicin as induction therapy in combination with cytarabine, in adult patients with AML. The pharmacoeconomic position of idarubicin in postinduction therapy remains to be established.",null,"New Zealand",1993,null,"Conventional Chemo",null,"Unknown","Unknown","Narrative Review"]
[77,"Yu, Y. B., et al. (2007). \"Cost-effectiveness of postremission intensive therapy in patients with acute leukemia.\" Ann Oncol 18(3): 529-534.",null,"Yu, Y. B., et al.","Cost-effectiveness of postremission intensive therapy in patients with acute leukemia","BACKGROUND: We assessed the cost-effectiveness of high-dose arabinoside (HiDAC)-based and allogeneic stem-cell transplantation (alloSCT)-based therapy in patients with acute leukemia. PATIENTS AND METHODS: We analyzed the outcome, cost and cost-effectiveness of 106 patients treated from January 1994 to January 2002 [94 acute myelogenous leukemia (AML)/12 acute lymphoblastic leukemia (ALL)]. Forty-two young patients at either intermediate or unknown cytogenetic risk received postremission intensive therapy (24 HiDAC-based/18 alloSCT-based therapy). RESULTS: After a median follow-up of 50 months, the estimated 7-year overall survival for the HiDAC-based group showed a tendency to be higher than the alloSCT-based group (48% versus 28%, P = 0.1452). The HiDAC-based group spent a significantly lower total cost ($US51,857 versus 75,474, P = 0.004) than the alloSCT-based group. Cost-effectiveness analysis showed that the mean cost per year of life saved for the HiDAC-based group is considerably less expensive than the alloSCT-based group ($US11,224 versus 21,564). The reduced total cost for the HiDAC-based group originated from lower cost in room fees, medication, laboratory and procedure, but not in blood transfusion and professional manpower fees. CONCLUSION: For the postremission therapy in young AML patients at either intermediate or unknown cytogenetic risk, cost-effectiveness of HiDAC-based therapy compares favorably with that of alloSCT-based therapy, which deserves further clinical trials.",null,"China",2007,null,"Stem Cell Therapy,Conventional Chemo",null,"General","Direct","Cohort Study"]
[78,"Zhao, Y. J., et al. (2015). \"Network Meta-analysis and Pharmacoeconomic Evaluation of Fluconazole, Itraconazole, Posaconazole, and Voriconazole in Invasive Fungal Infection Prophylaxis.\" Antimicrob Agents Chemother 60(1): 376-386.",null,"Zhao, Y. J., et al.","Network Meta-analysis and Pharmacoeconomic Evaluation of Fluconazole, Itraconazole, Posaconazole, and Voriconazole in Invasive Fungal Infection Prophylaxis","Invasive fungal infections (IFIs) are associated with high mortality rates and large economic burdens. Triazole prophylaxis is used for at-risk patients with hematological malignancies or stem cell transplants. We evaluated both the efficacy and the cost-effectiveness of triazole prophylaxis. A network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating fluconazole, itraconazole capsule and solution, posaconazole, and voriconazole was conducted. The outcomes of interest included the incidences of IFIs and deaths. This was coupled with a cost-effectiveness analysis from patient perspective over a lifetime horizon. Probabilities of transitions between health states were derived from the NMA. Resource use and costs were obtained from the Singapore health care institution. Data on 5,505 participants in 21 RCTs were included. Other than itraconazole capsule, all triazole antifungals were effective in reducing IFIs. Posaconazole was better than fluconazole (odds ratio [OR], 0.35 [95% confidence interval [CI], 0.16 to 0.73]) and itraconazole capsule (OR, 0.25 [95% CI, 0.06 to 0.97]), but not voriconazole (OR, 1.31 [95% CI, 0.43 to 4.01]), in preventing IFIs. Posaconazole significantly reduced all-cause deaths, compared to placebo, fluconazole, and itraconazole solution (OR, 0.49 to 0.54 [95% CI, 0.28 to 0.88]). The incremental cost-effectiveness ratio for itraconazole solution was lower than that for posaconazole (Singapore dollars [SGD] 12,546 versus SGD 26,817 per IFI avoided and SGD 5,844 versus SGD 12,423 per LY saved) for transplant patients. For leukemia patients, itraconazole solution was the dominant strategy. Voriconazole was dominated by posaconazole. All triazole antifungals except itraconazole capsule were effective in preventing IFIs. Posaconazole was more efficacious in reducing IFIs and all-cause deaths than were fluconazole and itraconazole. Both itraconazole solution and posaconazole were cost-effective in the Singapore health care setting.",null,"Singapore",2015,null,"Antifungal",null,"General","Direct","Meta Analysis"]

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[1,"Al-Badriyeh,D.,et al. (2010). \"Pharmacoeconomic evaluation of voriconazole versus posaconazole for antifungal prophylaxis in acute myeloid leukaemia.\" J Antimicrob Chemother 65(5): 1052-1061.",null,"Al-Badriyeh,D.,et al.","Pharmacoeconomic evaluation of voriconazole versus posaconazole for antifungal prophylaxis in acute myeloid leukaemia","BACKGROUND: Voriconazole and posaconazole are used prophylactically against invasive fungal infection (IFI) in patients with acute myeloid leukaemia (AML). The current study attempted to evaluate the economics of voriconazole versus posaconazole for prophylaxis in AML. METHODS: A 6 year (2003-09) retrospective chart review of AML patients was performed at a major Australian tertiary hospital. Patients were followed through the induction stage of chemotherapy,estimating outcome probabilities and prescribing patterns of antifungal prophylaxis. Cost inputs were obtained from the latest Australian sources. A decision analytical model was developed to depict options and consequences involved in the prophylaxis,including success,survival,possible and proven IFIs,and discontinuations due to intolerance. A cost-benefit analysis and an uncertainty study through sensitivity analyses were performed. RESULTS: Fifty-six and 38 patients were evaluated in the voriconazole and posaconazole groups,respectively. Baseline demographic characteristics were not significantly different between the study cohorts. Posaconazole was associated with an overall cost saving of AU$17,458 (29%) per patient over voriconazole. The posaconazole group was associated with lower rate of death,as well as lower probability of discontinuation because of possible infections and intolerance to oral administration. The voriconazole group was associated with fewer proven infections. As per sensitivity analyses,results were highly robust over variations in all costs and probabilities in the model. Monte Carlo simulation suggested a 91.6% chance for posaconazole to cost less than voriconazole. CONCLUSIONS: This is the first economic evaluation of voriconazole versus posaconazole; where posaconazole appears to be more cost-beneficial than voriconazole as antifungal prophylaxis in AML.",null,"Australia",2010,null,"Antifungal",null,"General","Direct","Retrospective Analysis","Australia","General",null,"Antifungal","Direct","Retrospective Analysis",null,"2010:2014"]
[2,"Aplenc,R.,et al. (2012). \"Merging of the National Cancer Institute-funded cooperative oncology group data with an administrative data source to develop a more effective platform for clinical trial analysis and comparative effectiveness research: a report from the Children's Oncology Group.\" Pharmacoepidemiol Drug Saf 21 Suppl 2: 37-43.",null,"Aplenc,R.,et al.","Merging of the National Cancer Institute-funded cooperative oncology group data with an administrative data source to develop a more effective platform for clinical trial analysis and comparative effectiveness research: a report from the Children's Oncology Group","PURPOSE: The National Cancer Institute-funded cooperative oncology group trials have improved overall survival for children with cancer from 10% to 85% and have set standards of care for adults with malignancies. Despite these successes,cooperative oncology groups currently face substantial challenges. We are working to develop methods to improve the efficiency and effectiveness of these trials. Specifically,we merged data from the Children's Oncology Group (COG) and the Pediatric Health Information Systems (PHIS) to improve toxicity monitoring,to estimate treatment-associated resource utilization and costs,and to address important clinical epidemiology questions. METHODS: COG and PHIS data on patients enrolled on a phase III COG trial for de novo acute myeloid leukemia at 43 PHIS hospitals were merged using a probabilistic algorithm. Resource utilization summary statistics were then tabulated for the first chemotherapy course based on PHIS data. RESULTS: Of 416 patients enrolled on the phase III COG trial at PHIS centers,392 (94%) were successfully matched. Of these,378 (96%) had inpatient PHIS data available beginning at the date of study enrollment. For these,daily blood product usage and anti-infective exposures were tabulated and standardized costs were described. CONCLUSIONS: These data demonstrate that patients enrolled in a cooperative group oncology trial can be successfully identified in an administrative data set and that supportive care resource utilization can be described. Further work is required to optimize the merging algorithm,map resource utilization metrics to the National Cancer Institute Common Toxicity Criteria for monitoring toxicity,to perform comparative effectiveness studies,and to estimate the costs associated with protocol therapy.",null,"USA",2012,null,"Various",null,"General","Resource Use","Clinical trial","USA","General",null,"Various","Resource Use","Clinical trial",null,"2010:2014"]
[3,"Balducci,L.,et al. (1993). \"Cost-effectiveness of white cell-reduction filters in treatment of adult acute myelogenous leukemia.\" Transfusion 33(8): 665-670.",null,"Balducci,L.,et al.","Cost-effectiveness of white cell-reduction filters in treatment of adult acute myelogenous leukemia","The objective of this study was to compare the cost and cost-effectiveness of three transfusion strategies in the treatment of acute myelogenous leukemia: 1) the use of unfiltered pooled platelets until alloimmunization developed and of crossmatch-compatible single-donor platelets thereafter; 2) the use of filtered blood components until alloimmunization occurred and of crossmatch-compatible single-donor platelets thereafter; and 3) the use of single-donor platelets from the beginning. The data sources were English language articles on transfusion medicine in acute leukemia and the management of acute leukemia and review of the transfusion experience at the H. Lee Moffitt Cancer Center. The method was decision analysis with a software program for cost-effectiveness,sensitivity analysis,threshold evaluation,and Monte Carlo sensitivity analysis. In the basic models,the total costs of the first,second,and third strategies are,respectively,$12,557.14,$11,406.17,and $13,016.16 without bone marrow transplant and $14,002.72,$12,281.89,and $13,727.48 with bone marrow transplant. The threshold between the first and second strategies in regard to risk of refractoriness to filtered blood components and pooled platelets was 0.30 and 0.27,respectively,without bone marrow transplant and 0.28 and 0.40 with bone marrow transplant. According to a Monte Carlo sensitivity analysis of 500 samples,the second strategy is more cost-effective than the first in 76 percent of cases. It is concluded that the use of filtered blood components is unlikely to increase the cost of treatment.",null,"USA",1993,null,"Supportive Care",null,"General","Direct","Retrospective Analysis","USA","General",null,"Supportive Care","Direct","Retrospective Analysis",null,"1960:1999"]
[4,"Barr,R.,et al. (1996). \"Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy.\" J Clin Oncol 14(5): 1413-1420.",null,"Barr,R.,et al.","Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy","PURPOSE: To provide an evidence-based approach to the formulation of clinical policy with respect to allogeneic bone marrow transplantation (BMT) that involves perceived trade offs between two major factors: costs and consequences. The report also highlights key informational deficiencies. PATIENTS AND METHODS: Adults with acute myeloid leukemia (AML) in second complete remission (2CR) and those with acute lymphoblastic leukemia (ALL) in first complete remission (1CR) were assigned to BMT or control groups solely on the availability of a suitable donor. All hospital-borne costs were estimated,based on services used according to manual chart review,in four categories: diagnostic and therapeutic costs,professional fees,drug costs,and ward costs. Incremental costs and incremental life-years were calculated,and the quotient determined a cost per life-year gained by BMT for AML (2CR) and ALL (1CR). RESULTS: The incremental cost (in 1992 Canadian dollars) per life-year gained by BMT (cost-effectiveness) for AML (2CR) was $29,200; and for ALL (1CR) it was minus $29,200. CONCLUSION: For AML (2CR),allogeneic BMT creates better outcomes than standard treatment,but is more costly. For ALL (1CR),both the costs and outcomes are similar for BMT and standard therapy. Quality adjustments made to life-years gained did not change these conclusions.",null,"Canada",1996,null,"Stem Cell Therapy",null,"Adults","Direct","Cohort Study","Canada","Adults",null,"Stem Cell Therapy","Direct","Cohort Study",null,"1960:1999"]
[5,"Bennett,C. L.,et al. (1997). \"Economic analyses of phase III cooperative cancer group clinical trials: are they feasible?\" Cancer Invest 15(3): 227-236.",null,"Bennett,C. L.,et al.","Economic analyses of phase III cooperative cancer group clinical trials: are they feasible?","Both economic and clinical evaluations of new pharmaceutical agents are important to physicians who practice in the current health care environment. While cooperative cancer groups carry out large-scale phase III clinical evaluations of these agents,few cooperative group studies incorporate economic analyses because of concerns over overburdening of data management,investigators,and statistical center personnel. In this study,we describe the results and operational considerations of one of the first completed economic analyses of a phase III cooperative group trial of the Eastern Cooperative Oncology Group (ECOG). We developed an economic model estimating economic benefits of yeast-derived granulocyte-macrophage colony-stimulating factor (GM-CSF) as adjunct therapy for adult patients (56-70 years) with acute myelogenous leukemia. Clinical data were based on prospectively collected information from a recently reported double-blind phase III multi-institutional study carried out by ECOG. Retrospective economic data were obtained from financial information systems at our hospital,one of the study sites. The cost-minimization analyses were based on the perspective of a third-party payer. Indirect costs related to loss of earnings by patients and caregivers as well as quality-of-life adjustments were not incorporated into the model. Clinical trial results indicated that patients treated with GM-CSF had shorter times to recovery of absolute neutrophil count of 500 cells/mm3 and 1000 cells/mm3 and fewer serious infections than patients who received placebo following induction chemotherapy,while no significant differences were noted in red blood cell and platelet transfusion dependency,toxicities,and duration of hospitalization. The economic model estimated that the group treated with GM-CSF was estimated to have lower costs of care,associated with lower frequencies of serious infections and lower overall infection-related costs. Sensitivity analyses indicated that these results held true over a wide range of estimates of costs and infection rates. Prospective economic analyses of phase III cooperative cancer group clinical trials have not been completed to date. Strategies that are not likely to overburden data managers and statistical center personnel are possible to devise. However,these studies require careful planning and coordination between clinical trialists,economists,and health services researchers.",null,"USA",1997,null,"CSF",null,"Adults","Indirect","Retrospective Analysis","USA","Adults",null,"CSF","Indirect","Retrospective Analysis",null,"1960:1999"]
[6,"Bennett,C. L.,et al. (2001). \"Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): estimates from a Southwest Oncology Group clinical trial.\" Cancer Invest 19(6): 603-610.",null,"Bennett,C. L.,et al.","Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): estimates from a Southwest Oncology Group clinical trial","Considerable morbidity,mortality,and economic costs result during remission induction therapy for elderly patients with acute myeloid leukemia (AML). In this study,the economic costs of adjunct granulocyte colony stimulating factor (G-CSF) are estimated for AML patients > 55 years of age who received induction chemotherapy on a recently completed Southwest Oncology Group study (SWOG). Clinical data were based on Phase III trial information from 207 AML patients who were randomized to receive either placebo or G-CSF post-induction therapy. Analyses were conducted using a decision analytic model with the primary source of clinical event probabilities based on in-hospital care with or without an active infection requiring intravenous antibiotics. Estimates of average daily costs of care with and without an infection were imputed from a previously reported economic model of a similar population. When compared to AML patients who received placebo,patients who received G-CSF had significantly fewer days on intravenous antibiotics (median 22 vs. 26,p = 0.05),whereas overall duration of hospitalization did not differ (median 29 days). The median cost per day with an active infection that required intravenous antibiotics was estimated to be $1742,whereas the median cost per day without an active infection was estimated to be $1467. Overall,costs were $49,693 for the placebo group and $50,593 for the G-CSF patients. G-CSF during induction chemotherapy for elderly patients with AML had some clinical benefits,but it did not reduce the duration of hospitalization,prolong survival,or reduce the overall cost of supportive care. Whether the benefits of G-CSF therapy justify its use in individual patients with acute leukemia for the present remains a matter of clinical judgment.",null,"USA",2001,null,"CSF,Antibiotics",null,"Elderly","Direct","Retrospective Analysis","USA","Elderly",null,"CSF,Antibiotics","Direct","Retrospective Analysis",null,"2000:2004"]
[7,"Bennett,C. L. and G. T. Schumock (2003). \"Cost analyses of adjunct colony stimulating factors for older patients with acute myeloid leukaemia : can they improve clinical decision making?\" Drugs Aging 20(7): 479-483.",null,"Bennett,C. L. and G. T. Schumock","Cost analyses of adjunct colony stimulating factors for older patients with acute myeloid leukaemia : can they improve clinical decision making?","Colony stimulating factors (CSF) have been shown to reduce the duration of neutropenia following intensive chemotherapy in a variety of settings,with many of these studies targeting older patients with leukaemia. We review the clinical and economic findings for use of growth factors for older adults with acute myelogenous leukaemia (AML). The cost analyses were based on the perspective of the third party payer. One study,conducted by the Southwest Oncology Group (SWOG) randomised 207 AML patients to receive granulocyte colony-stimulating factor (G-CSF) or placebo and found no significant difference in number of infections and in days of hospitalisation,3 fewer days with an absolute neutrophil count <500 cells/microL with G-CSF,and an estimated incremental cost of only US 120 dollars with G-CSF over placebo (1997 costs). A second study,conducted by the Eastern Cooperative Oncology Group (ECOG),randomised 119 AML patients to receive granulocyte-macrophage colony-stimulating factor (GM-CSF) or placebo and found a reduction in severe infections,4 fewer days with an absolute neutrophil count <500 cells/microL,no significant difference in the duration of hospitalisation,and estimated cost savings of US 2310 dollars with GM-CSF (1997 costs). These data may be useful to physicians faced with concerns over clinical and economic factors associated with CSF use as adjunct therapy for older persons with AML.",null,"USA",2003,null,"CSF",null,"General","Direct","Narrative Review","USA","General",null,"CSF","Direct","Narrative Review",null,"2000:2004"]
[8,"Bennett,C. L.,et al. (2000). \"Cost analyses of adjunct colony stimulating factors for acute leukemia: can they improve clinical decision making.\" Leuk Lymphoma 37(1-2): 65-70.",null,"Bennett,C. L.,et al.","Cost analyses of adjunct colony stimulating factors for acute leukemia: can they improve clinical decision making","Colony stimulating factors reduce the duration of neutropenia following intensive chemotherapy in a variety of settings,but the advantages in the management of leukemia are inconclusive. The variations in clinical results and the high costs of granulocyte colony-stimulating factor (G-CSF) and granulocyte macrophage colony-stimulating factor (GM-CSF) have led to confusion over appropriate use for leukemia patients. In this paper,we reviewed published information on costs and cost-effectiveness of growth factors for childhood and adult leukemia patients. Medline and Healthstar databases were searched for original research articles that contain cost or cost-effectiveness analyses of G-CSF (filgrastim) and GM-SCF (sargramostim) in oncology cooperative group trials. Published manuscripts and abstracts presented at national or international oncology conferences were included. The cost of adjunct treatment was evaluated in two studies of pediatric ALL,one study of adult AML,and two studies of AML in older adults (>55 years). The use of G-CSF for children with ALL was associated with reductions in days to ANC recovery,fewer documented infections,a shorter duration of hospitalization,and small (but not significant) additional costs. In adult AML patients,benefits included a shortening of the duration of neutropenia and hospital stays,a lower incidence of infection and febrile episodes,less use of antibiotics,and cost savings of $2,230 and $2,310 in two studies and an increase if $120 in the third study. This summary suggests that economic analyses can provide useful information to assist clinical decision-making. For pediatric ALL patients,this information indicates that G-CSF use is unlikely to have significant cost implications,and its use should be based on clinical considerations. In studies of adult and older adult AML patients,both GM-CSF and G-CSF have clinical benefits and can be expected to lead to a decrease in overall costs.",null,"USA",2000,null,"CSF",null,"Children,Adults,Elderly","Direct","Systematic Review","USA","Children,Adults,Elderly",null,"CSF","Direct","Systematic Review",null,"2000:2004"]
[9,"Bennett,C. L.,et al. (1999). \"Economic analysis of a randomized placebo-controlled phase III study of granulocyte macrophage colony stimulating factor in adult patients (> 55 to 70 years of age) with acute myelogenous leukemia. Eastern Cooperative Oncology Group (E1490).\" Ann Oncol 10(2): 177-182.",null,"Bennett,C. L.,et al.","Economic analysis of a randomized placebo-controlled phase III study of granulocyte macrophage colony stimulating factor in adult patients (> 55 to 70 years of age) with acute myelogenous leukemia. Eastern Cooperative Oncology Group (E1490)","PURPOSE: Considerable morbidity and mortality and costs occur during induction therapy for acute myeloid leukemia (AML). Colony-stimulating factors (CSFs) can shorten neutropenia,and may lower costs. We performed a cost-minimization analysis of granulocyte macrophage colony stimulating factor (GM-CSF) for AML patients > 55 to 70 years of age during an Eastern Cooperative Oncology Group Study. PATIENTS AND METHODS: Clinical data were from a randomized double-blind phase III trial of 117 AML patients. Estimates of costs were from financial accounts from seven participating institutions. Costs were reported from the third party payor perspective. Analyses were conducted utilizing a decision analytic model. The primary source of event probabilities was in-hospital care with or without an active infection. Sensitivity analyses were also reported. RESULTS: When compared to AML patients who received placebo. GM-CSF patients had fewer grade 4-5 infections (9.6% versus 36.2%,P = 0.002) and grade 3-5 infections (52% versus 70%. P = 0.07) and $2.310 in savings. Sensitivity analyses indicated that similar cost estimates applied over a range of clinical and economic assumptions. CONCLUSIONS: This analysis can serve as a template for cooperative group cost analyses. Cooperation on study methodologies may allow for results that are relevant to both clinicians and policy makers.",null,"USA",1999,null,"CSF",null,"Elderly","Direct,Indirect","RCT","USA","Elderly",null,"CSF","Direct,Indirect","RCT",null,"1960:1999"]
[10,"Brodin,H. and A. M. Stalfelt (1993). \"Treating acute leukaemias--a venture into economic uncertainty? A method for estimating the cost of treating patients with acute myelocytic leukaemia.\" Acta Oncol 32(5): 501-505.",null,"Brodin,H. and A. M. Stalfelt","Treating acute leukaemias--a venture into economic uncertainty? A method for estimating the cost of treating patients with acute myelocytic leukaemia","The objective of this paper is to report a method for estimating the cost of treating acute myelocytic leukaemia (AML). It is based on individual data from 54 patients treated with aggressive induction courses of chemotherapy. The study records the cost of the entire survival period for 40 patients and of at least 16 months' survival for the remaining 14 patients. All treatment activities were registered from the patient records and the price of each activity was estimated. As far as possible the principle of opportunity cost was used. The median survival time was 50 weeks and the average cost per patient was c. 300,000 SEK (= c. USD 50,000) in 1988 prices. A young man who achieved three remissions and lived for five years had the highest cost,c. 1 million SEK (= USD 155,000). The costs for AML treatment was higher in the 1980s than in the 1970s but led to longer survival for patients who survived the initial period.",null,"Sweden",1993,null,"Conventional Chemo",null,"General","Direct","Retrospective Review","Sweden","General",null,"Conventional Chemo","Direct","Retrospective Review",null,"1960:1999"]
[11,"Chan,T. S.,et al. (2016). \"Posaconazole vs fluconazole or itraconazole for prevention of invasive fungal diseases in patients with acute myeloid leukemia or myelodysplastic syndrome: a cost-effectiveness analysis in an Asian teaching hospital.\" J Med Econ 19(1): 77-83.",null,"Chan,T. S.,et al.","Posaconazole vs fluconazole or itraconazole for prevention of invasive fungal diseases in patients with acute myeloid leukemia or myelodysplastic syndrome: a cost-effectiveness analysis in an Asian teaching hospital","BACKGROUND: Posaconazole is superior to fluconazole/itraconazole in preventing invasive fungal diseases (IFDs) in neutropenic patients. Whether the higher cost of posaconazole is offset by decreases in IFDs in a given institute requires cost-effective analysis encompassing the spectrum of IFDs and socioeconomic factors specific to that geographic area. METHODS: This study performed a cost-effective analysis of posaconazole prophylaxis for IFDs in an Asian teaching hospital,employing decision modeling and data of IFDs and medication costs specific to the institute,in neutropenic patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). RESULTS: In the cost-effectiveness analysis,the higher cost of posaconazole was partially offset by a reduction in the cost of treating IFDs that were prevented,resulting in an incremental cost of 125,954 Hong Kong dollars/16,148 USD per IFD avoided. Over a lifetime horizon,assuming same case fatality rate of IFDs in both groups,use of posaconazole results in 0.07 discounted life years saved. This corresponds to an incremental cost of 116,023 HKD/14,875 USD per life year saved. This incremental cost per life year saved in posaconazole prophylaxis fulfilled the World Health Organization defined threshold for cost-effectiveness. CONCLUSION: Posaconazole prophylaxis was cost-effective in Hong Kong.",null,"China",2016,null,"Antifungal",null,"General","Direct","Retrospective Review","China","General",null,"Antifungal","Direct","Retrospective Review",null,"2015:2018"]
[12,"Cho,S. Y.,et al. (2015). \"Cost-benefit Analysis of Posaconazole Versus Fluconazole or Itraconazole as a Primary Antifungal Prophylaxis in High-risk Hematologic Patients: A Propensity Score-matched Analysis.\" Clin Ther 37(9): 2019-2027.",null,"Cho,S. Y.,et al.","Cost-benefit Analysis of Posaconazole Versus Fluconazole or Itraconazole as a Primary Antifungal Prophylaxis in High-risk Hematologic Patients: A Propensity Score-matched Analysis","PURPOSE: Posaconazole is effective for the prophylaxis of invasive fungal infections (IFIs) in patients with acute myeloid leukemia or myelodysplastic syndrome during remission induction chemotherapy. However,a cost-benefit analysis of posaconazole versus fluconazole or itraconazole has not been conducted in Korea. METHODS: We retrospectively reviewed data for all consecutive patients who received primary antifungal prophylaxis during remission induction chemotherapy in our acute myeloid leukemia/myelodysplastic syndrome cohort from December 2010 to November 2013. Patient characteristics and factors known as a risk of IFI were matched with propensity score analysis. We evaluated the medical cost according to the prophylactic antifungal agents (posaconazole vs fluconazole/itraconazole),the development of breakthrough IFIs,and survival status after propensity score matching in a 1:1 ratio. FINDINGS: Of the 419 baseline patients,100 patients in each group were analyzed after matching. A significant decrease was found in the development of breakthrough proven or probable IFIs (3.0% vs 14.0%; P = 0.009) and the rate of empirical antifungal therapy (EAFT) (12.0% vs 46.0%; P < 0.001) in the posaconazole group. Total in-hospital medical costs per patient were not statistically different between posaconazole and fluconazole/itraconazole prophylaxis. However,the daily medical cost was lower for posaconazole prophylaxis,resulting in a total daily cost savings of $72 (79,458) per patient (P = 0.002). In the cases of breakthrough proven/probable IFIs,EAFT,and in-hospital deaths,the total medical costs per patient were significantly higher than in nonproven/probable IFIs,non-EAFT,and in-hospital survivors,as much as $7,916 (8,700,758),$4605 (5,062,529),and $11,134 (12,238,422),respectively. Costs for the antifungal agent used in targeted or empirical therapy were lower in the posaconazole group,resulting in a savings of $697 (766,347) per patient (P < 0.001). IMPLICATIONS: Posaconazole appears to be cost beneficial for primary antifungal prophylaxis in high-risk patients with hematologic malignancy,at a single center,in Korea. Cost-benefit is closely related with clinical outcomes,including breakthrough IFI development,EAFT,and survival status.",null,"Republic of Korea",2015,null,"Antifungal",null,"General","Direct","Retrospective Review","Republic of Korea","General",null,"Antifungal","Direct","Retrospective Review",null,"2015:2018"]
[13,"Chong,G. L.,et al. (2015). \"Aerosolised liposomal amphotericin B to prevent aspergillosis in acute myeloid leukaemia: Efficacy and cost effectiveness in real-life.\" Int J Antimicrob Agents 46(1): 82-87.",null,"Chong,G. L.,et al.","Aerosolised liposomal amphotericin B to prevent aspergillosis in acute myeloid leukaemia: Efficacy and cost effectiveness in real-life","Chemotherapy-induced neutropenia can be complicated by invasive pulmonary aspergillosis (IPA). In 2008,liposomal amphotericin B (L-AmB) inhalation was shown to prevent IPA in a placebo-controlled trial. Patients with acute myeloid leukaemia (AML) are the subset of haematology patients at high risk for IPA. In 2008,L-AmB inhalation prophylaxis became the standard of care for all AML patients in Erasmus MC. In this study,the efficacy and cost effectiveness of L-AmB inhalation were evaluated in a prospective cohort of AML patients. In total,127 consecutive AML patients received chemotherapy and prophylactically inhaled L-AmB during their first and second chemotherapy cycles; 108 patients treated for AML at the same sites from 2005-2008 served as controls. A standardised diagnostic protocol was used and probable/proven IPA served as the primary endpoint. Diagnostic and therapeutic costs were also comprehensively analysed and compared. A significant decrease in probable/proven IPA in the L-AmB inhalation group was observed (L-AmB 9.5% vs. controls 23.4%; P=0.0064). Systemic antifungal therapy given at any time during the entire AML therapy decreased from 52.8% to 29.9%. Per-patient equipment and drug costs for L-AmB inhalation (1292 euro/patient) were more than compensated for by a decrease in costs for diagnostics and therapeutic voriconazole use (-1816 euro/patient). No serious adverse events related to L-AmB inhalation were observed. In an unselected AML patient group,L-AmB inhalation resulted in a significant and substantial decrease in IPA and was cost saving. Now that azole resistance is more frequent,non-azole-based prophylaxis may become an attractive strategy.",null,"The Netherlands",2015,null,"Antifungal",null,"General","Direct","Cohort Study","The Netherlands","General",null,"Antifungal","Direct","Cohort Study",null,"2015:2018"]
[14,"Clavio,M.,et al. (2001). \"Cost of de novo acute myeloid leukemia induction therapy in adults: analysis of EORTC-GIMEMA AML10 and FLANG regimens.\" J Exp Clin Cancer Res 20(2): 165-173.",null,"Clavio,M.,et al.","Cost of de novo acute myeloid leukemia induction therapy in adults: analysis of EORTC-GIMEMA AML10 and FLANG regimens","Since the social and financial impact of AML therapy is becoming more and more relevant we analyzed the cost of induction therapy of two different regimens. The first one is part of the widely employed EORTC-GIMEMA AML-10 and consists often days of therapy. The second (FLANG) is a short (three day),Fludarabine,Ara-C,mitoxantrone and G-CSF containing regimen. We first retrospectively analyzed the outcome of 77 consecutive AML patients with comparable clinical and haematological features receiving FLANG (25) or AML-10 (52),between June 1993 and October 1999,and observed equivalent CR rate,as well as DFS and overall survival duration. We then selected 9 non pretreated patients per group who reached CR after one course of therapy. Patients treated with FLANG had a statistically significant earlier platelet recovery compared to those treated with AML-10,fewer days of intravenous antibiotic therapy (14/22,respectively,p < 0.05),and a shorter hospitalization period (22/33 days,p < 0.01). FLANG was significantly more expensive than AML 10 as far as the cost of antiblastic drugs (p < 0.01) and G-CSF support (p < 0.05) are concerned. On the contrary,the expense for antiemetic drugs (p < 0.01) and the cost of personnel and other services ($5,906/$3,970,p < 0.05) were higher for AML-10 than for FLANG. Overall,the average costs of FLANG and AML10 were $9,269 and $12,424 respectively (p < 0.05; difference = -25%). Our study seems to indicate that,compared to AML-10,FLANG induction is as effective,less expensive and it allows for a decrease in the length of hospitalization and thus for better exploitation of the financial resources of Hematology-Oncology departments.",null,"Italy",2001,null,"Conventional Chemo,CSF,Mitoxantrone",null,"General","Resource Use","Retrospective Analysis","Italy","General",null,"Conventional Chemo,CSF,Mitoxantrone","Resource Use","Retrospective Analysis",null,"2000:2004"]
[15,"Cordonnier,C.,et al. (2005). \"Do minitransplants have minicosts? A cost comparison between myeloablative and nonmyeloablative allogeneic stem cell transplant in patients with acute myeloid leukemia.\" Bone Marrow Transplant 36(7): 649-654.",null,"Cordonnier,C.,et al.","Do minitransplants have minicosts? A cost comparison between myeloablative and nonmyeloablative allogeneic stem cell transplant in patients with acute myeloid leukemia","Allogeneic hematopoietic stem cell transplantation (SCT) is a widely used,cost-intensive procedure. Although pretransplant nonmyeloablative (NMA) or reduced-intensity conditioning regimens appear very promising,prospective studies comparing this approach with the conventional myeloablative (MA) approach in specific hematologic diseases are necessary,especially in patients in whom the conventional approach is not contraindicated. Cost may be an important factor in the decision-making process. We compared the costs of MA and NMA transplants in patients with acute myeloid leukemia (AML). We estimated 1-year resource utilization in 12 consecutive MA patients (median age: 39 years) and in 11 consecutive NMA patients (median age: 58 years) who underwent HLA-identical sibling SCT for AML. Resources care expenses were valued using the average daily rate for personnel costs,supplies,and room costs. Other data were directly collected from the patients' charts. Despite a trend for lower costs in NMA patients during the first 6 months,costs during the 6-12-month period were significantly higher after NMA due to late complications and readmissions (P=0.03). Finally,mean 1-year costs were not different in MA and NMA patients (P=0.75). Prospective studies comparing conventional and NMA approaches in homogeneous populations should include economic items.",null,"France",2005,null,"Stem Cell Therapy",null,"Adults,Elderly","Direct,Indirect,Resource Use","Cohort Study","France","Adults,Elderly",null,"Stem Cell Therapy","Direct,Indirect,Resource Use","Cohort Study",null,"2005:2009"]
[16,"Costa,V. C.,et al. (2003). \"Resource utilization and cost of episodes of febrile neutropenia in children with acute leukemias and lymphomas.\" Support Care Cancer 11(6): 356-361.",null,"Costa,V. C.,et al.","Resource utilization and cost of episodes of febrile neutropenia in children with acute leukemias and lymphomas","The resource utilization and cost of 51 episodes of febrile neutropenia in children with leukemia and lymphomas who were admitted to the Pediatric Oncology Institute (GRAAC) of the Federal University of Sao Paulo were analyzed. Patients aged 60 days to 21 years with confirmed diagnoses of acute myeloid leukemia,acute lymphoid leukemia,non-Hodgkin lymphoma,or Hodgkins disease who presented axillary temperature above 38 degrees C at least once episode,or between 37.5 degrees C and 38 degrees C on three occasions during a 24-h period,neutrophil count below 500/mm(3),or between 500/mm(3)and 1,000/mm(3) but expected to fall below 500/mm(3) were included in the study. The patients' ages varied between 1 and 15.6 years,and 67% of the patients were male. The median cost per treated episode was US dollars 2,660 (2,039). Hospitalization costs accounted for 62% of the total cost of the treatment,antibacterials accounting for 23%. Episodes in patients with documented infections had a higher median direct cost than episodes in patients with fever of unknown origin (P=0.018). There was a trend for a higher median direct cost in episodes among patients with a worse prognostic factor,such as type of underlying disease,presence of documented infection,and longer duration of neutropenia. This is the first study to evaluate the economics of febrile neutropenia episodes in Brazil,and serves as a basis for resource utilization and costs incurred in the treatment of such patients in this country.",null,"Brazil",2003,null,"Unknown",null,"Children","Direct,Resource use","Retrospective Analysis","Brazil","Children",null,"Unknown","Direct,Resource Use","Retrospective Analysis",null,"2000:2004"]
[17,"Craig,B. M.,et al. (2011). \"Diagnostic testing,treatment,cost of care,and survival among registered and non-registered patients with myelodysplastic syndromes.\" Leuk Res 35(11): 1453-1456.",null,"Craig,B. M.,et al.","Diagnostic testing,treatment,cost of care,and survival among registered and non-registered patients with myelodysplastic syndromes","Considering current reliance on cancer registry data,we sought to assess the potential for bias in myelodysplastic syndrome (MDS) registration using SEER-Medicare data 2001-2005. Using a validated claims-based algorithm,we identified and compared registered and non-registered MDS patients,and found that median cumulative survival was 18 and 28 months,74% and 64% used erythropoiesis-stimulating agents (ESAs),and average 6-month health care cost was $24,249 and $21,750,respectively. While most non-registered MDS patients showed resource utilization and survival characteristics consistent with lower-risk MDS,a subset was registered as acute myeloid leukemia (7.6%) and accounted for early mortality.",null,"USA",2011,null,"Unknown",null,"General","Resource Use,Direct","Retrospective Analysis","USA","General",null,"Unknown","Resource Use,Direct","Retrospective Analysis",null,"2010:2014"]
[18,"Cressman,S.,et al. (2016). \"Economic impact of genomic diagnostics for intermediate-risk acute myeloid leukaemia.\" Br J Haematol 174(4): 526-535.",null,"Cressman,S.,et al.","Economic impact of genomic diagnostics for intermediate-risk acute myeloid leukaemia","Acute Myeloid Leukaemia (AML) is a rare but serious group of diseases that require critical decision-making for curative treatment. Over the past decade,scientific discovery has revealed dozens of prognostic gene mutations for AML while sequencing costs have plummeted. In this study,we compared the cost-effectiveness of multigene integrative analysis (genomic analysis) with the standard molecular testing currently used for diagnosis of intermediate-risk AML. We used a decision analytic model with data for costs and outcomes from British Columbia,Canada,to assess the long-term (10-year) economic impacts. Our results suggest that genomic analysis would result in a 26% increase in the use of first-remission allogeneic stem cell transplantation. The resulting treatment decisions and downstream effects would come at an additional cost of $12 556 [2013 Canadian dollars (CAD)] per person and the incremental cost-effectiveness ratio would be $49 493 per quality-adjusted life-year gained. Cost-effectiveness was dependent on quality of life during the long-term (5-10) years of survival,relapse rates following first-remission chemotherapy and the upfront cost of transplantation. Non-relapse mortality rates,short-term quality of life and the cost of genomic sequencing had only minor impacts. Further research on post-remission outcomes can lead to improvements in the cost-effectiveness of curative treatments for AML.",null,"Canada",2016,null,"Diagnostics",null,"General","Direct","Decision Analytic Model","Canada","General",null,"Diagnostics","Direct","Decision Analytic Model",null,"2015:2018"]
[19,"Dranitsaris,G. and H. Khoury (2011). \"Posaconazole versus fluconazole or itraconazole for prevention of invasive fungal infections in patients undergoing intensive cytotoxic therapy for acute myeloid leukemia or myelodysplasia: a cost effectiveness analysis.\" Support Care Cancer 19(11): 1807-1813.",null,"Dranitsaris,G. and H. Khoury","Posaconazole versus fluconazole or itraconazole for prevention of invasive fungal infections in patients undergoing intensive cytotoxic therapy for acute myeloid leukemia or myelodysplasia: a cost effectiveness analysis","INTRODUCTION: Invasive fungal infections (IFI) remain a clinical concern in hematological patients with prolonged neutropenia because they are a major cause of morbidity and mortality. In a recent randomized trial,prophylaxis with posaconazole was associated with fewer IFI and related deaths relative to a fluconazole or itraconazole (Flu/Itra) control group (p < 0.001). In the current study,a cost effectiveness analysis was conducted to estimate the economic value of posaconazole as an alternative to Flu/Itra when used to prevent IFI in this patient population. METHODS: A decision analysis model was developed using clinical and economic data from randomized comparative trials,the economic literature,and from expert opinion. The data were then used to estimate the incremental cost per life year saved with oral posaconazole prophylaxis relative to Flu/Itra from the Canadian provincial health care system perspective. The base case results were then tested with a sensitivity analysis which evaluated extremes in the incidence of IFI as well as variations in their cost of management. RESULTS: Prophylaxis with posaconazole provides increased efficacy and an overall cost savings of approximately $Can4,259 per patient. Despite variations in the base case parameters,the sensitivity analysis suggested stability in the primary findings. Posaconazole was associated with an overall cost savings (range = $Can1,765 to $Can4,505) in all of the scenarios evaluated. Optimal cost effectiveness was obtained because the drug was able to avoid the more resource intensive Aspergillus infections. CONCLUSIONS: Prophylaxis with posaconazole in cancer patients with prolonged neutropenia is not only cost effective but also cost saving. The economic benefits were due to the drug's ability to reduce the incidence of high cost fungal infections,particularly Aspergillus species.",null,"Canada",2011,null,"Antifungal",null,"General","Direct,Indirect","Decision Analytic Model","Canada","General",null,"Antifungal","Direct,Indirect","Decision Analytic Model",null,"2010:2014"]
[20,"Dufoir,T.,et al. (1992). \"Comparative cost of allogeneic or autologous bone marrow transplantation and chemotherapy in patients with acute myeloid leukaemia in first remission.\" Bone Marrow Transplant 10(4): 323-329.",null,"Dufoir,T.,et al.","Comparative cost of allogeneic or autologous bone marrow transplantation and chemotherapy in patients with acute myeloid leukaemia in first remission","We compared the direct costs of allogeneic bone marrow transplantation (Allo-BMT),autologous bone marrow transplantation (Auto-BMT) and chemotherapy (Chemo) in 40 adult patients under the age of 55 years with acute myeloid leukaemia (AML) in first complete remission (CR). Fourteen patients were treated with Allo-BMT,11 with Auto-BMT and 15 with Chemo. These patients,who were part of two cooperative consecutive trials enrolling a total of 196 patients (BGM 84 and BGMT 87 studies),were those who were treated in the CHR Bordeaux and achieved CR after induction chemotherapy. Cost accounting extended over a maximum period of 5 years. The average cost of the procedure for a mean follow-up of 2 years and excluding the cost of treatment after relapse which eventually occurred was significantly higher for the Allo-BMT group (FF 392,724) and the Auto-BMT group (FF 393,461) than for the group that received Chemo (FF 128,947) (p < 0.00001). The average cost for the treatment of relapse was estimated at FF 266,436,irrespective of the previous treatment. The total cost,including the estimated cost of relapse according to its probability of occurring calculated from the original population,was significantly higher for the Allo-BMT group (FF 424,696; p < 0.01) and the Auto-BMT group (FF 505,364; p < 0.0001) than for the Chemo group (FF 304,846).(ABSTRACT TRUNCATED AT 250 WORDS)",null,"France",1992,null,"Stem Cell Therapy,Conventional Chemo",null,"Adults","Direct","Clinical trial","France","Adults",null,"Stem Cell Therapy,Conventional Chemo","Direct","Clinical trial",null,"1960:1999"]
[21,"Dunn,C. J. and K. L. Goa (2000). \"Lenograstim: an update of its pharmacological properties and use in chemotherapy-induced neutropenia and related clinical settings.\" Drugs 59(3): 681-717.",null,"Dunn,C. J. and K. L. Goa","Lenograstim: an update of its pharmacological properties and use in chemotherapy-induced neutropenia and related clinical settings","Lenograstim is the glycosylated recombinant form of human granulocyte colony stimulating factor. The drug is used to reduce the risk of life-threatening infection in patients with neutropenia,particularly after cytotoxic chemotherapy. Lenograstim accelerates neutrophil recovery significantly after chemotherapy,with beneficial effects on clinical end-points such as incidence of laboratory-confirmed infection and length of hospital stay. Chemotherapy dose intensity has also been increased in patients receiving lenograstim,notably those with breast or small cell lung cancer,although improvements in tumour response and survival have not been demonstrated. Lenograstim also assists neutrophil recovery in patients undergoing bone marrow transplantation,and stimulates the production of peripheral blood stem cells (PBSCs) for autologous transfusion after aggressive chemotherapy. Lenograstim also mobilises CD34+ cells more efficiently in unit dose terms than filgrastim and has been used successfully to mobilise PBSCs from healthy donors for allogeneic transplantation. Randomised trials have shown increases in rates of disease remission after lenograstim therapy in patients with acute myeloid leukaemia,with no evidence of stimulation of malignant blasts. The drug has also shown potential in the mobilisation of nonmalignant PBSCs for autotransplantation in patients with chronic myeloid leukaemia. Other studies show efficacy of lenograstim in patients with acute lymphoblastic leukaemia,aplastic anaemia,in children with severe chronic neutropenia and in the reversal of neutropenia related to antiviral therapy in patients with AIDS,although data are not extensive. Cost analyses of lenograstim have been carried out from a hospital perspective,although results have been inconclusive. Cost-effectiveness or cost-benefit data are lacking at present. Lenograstim is well tolerated,with bone pain and injection site reactions being reported most frequently in clinical trials. CONCLUSIONS: Lenograstim has been confirmed as a valuable adjunct to minimise the haematological toxicity of myelosuppressive chemotherapy in patients with malignant disease. The drug also enhances neutrophil recovery in patients undergoing stem cell rescue,and assists PBSC mobilisation. Data indicate clinical benefit with lenograstim in myeloid disorders,with no evidence of malignant blast cell proliferation. Further studies are required to assess more fully the pharmacoeconomic implications of the use of lenograstim and other recombinant growth factors,to provide more data on the efficacy of the drug in the management of disease-related neutropenia,and to clarify fully its position relative to filgrastim.",null,"New Zealand",2000,null,"CSF",null,"General","Direct","Retrospective Review","New Zealand","General",null,"CSF","Direct","Retrospective Review",null,"2000:2004"]
[22,"Eardley,A. M.,et al. (1994). \"Morbidity and costs of remission induction therapy with all-trans retinoic acid compared with standard chemotherapy in acute promyelocytic leukemia.\" Leukemia 8(6): 934-939.",null,"Eardley,A. M.,et al.","Morbidity and costs of remission induction therapy with all-trans retinoic acid compared with standard chemotherapy in acute promyelocytic leukemia","With the recent pressure to control health care expenditures,the costs of patient participation in clinical trials,especially in their earliest phases,have come under increasingly intense scrutiny. We therefore reviewed our experience in patients with acute promyelocytic leukemia (APL) who were treated during the first US trial of a new experimental drug,all-trans retinoic acid (RA). The purpose of the review was to evaluate parameters of patient morbidity and financial cost associated with the use of all-trans RA compared with standard chemotherapy for induction of complete remission in newly-diagnosed patients with APL. We retrospectively compared outcomes of consecutive patients treated during the first 2 years of our studies that used all-trans RA for remission induction (1990-1992) with an identical number of patients consecutively treated with standard chemotherapy (cytosine arabinoside plus an anthracycline) during the immediately preceding period (1985-1990). Responding patients in both groups received post-remission chemotherapy. Evaluation parameters included transfusions of packed red blood cells and platelets,use of anti-bacterial and anti-fungal drugs,duration of fever,time to remission,length of hospital stay,hospital charges,and both overall and relapse-free survival. Thirty patients were evaluated in each group. Complete remission was achieved in 26 patients (87%) treated with all-trans RA,and 24 patients (77%) treated with chemotherapy (p = 0.5). In the chemotherapy group,there were five early deaths (four from hemorrhage,one from sepsis); one other patient was resistant to treatment and died at 6 months. Four patients in the all-trans RA group died prior to response from complications of the 'retinoic acid syndrome'. The median time to complete response by all criteria was 41 days (range,18-78) for the all-trans RA group and 50 days (range,24-121) for patients who received conventional chemotherapy (p = 0.2). Looking only at patients who achieved remission,chemotherapy-treated patients required a significantly greater number of platelet transfusions (medians,14 vs. 4; p < 0.001) and packed red blood cell transfusions (15 vs. 4; p < 0.001). Patients who received chemotherapy also experienced a significantly larger number of days with fever (13 vs. 6; p = 0.01) that was reflected in a greater median number of days on combination antibiotics (35 vs. 21; p = 0.001) and Amphotericin B (20 vs. 0; p < 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)",null,"USA",1994,null,"Various,Conventional Chemo",null,"General","Direct,Indirect","Retrospective Review","USA","General",null,"Various,Conventional Chemo","Direct,Indirect","Retrospective Review",null,"1960:1999"]
[23,"Edlin,R.,et al. (2010). \"Azacitidine for the treatment of myelodysplastic syndrome,chronic myelomonocytic leukaemia and acute myeloid leukaemia.\" Health Technol Assess 14 Suppl 1: 69-74.",null,"Edlin,R.,et al.","Azacitidine for the treatment of myelodysplastic syndrome,chronic myelomonocytic leukaemia and acute myeloid leukaemia","This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of azacitidine (aza) compared with conventional care regimes (CCR) for higher risk patients with myelodysplastic syndrome (MDS),chronic myelomonocytic leukaemia (CMML) and acute myeloid leukaemia (AML),based on the evidence submission from the manufacturer to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The patient outcomes governing relative effectiveness and cost-effectiveness were defined as overall survival,time to progression (TTP) to AML,adverse events and health-related quality of life (HRQoL). The clinical evidence was derived from an open-label randomised controlled trial referred to as study AZA-001. It compared aza with CCR in 358 patients with higher risk MDS,CMML and AML 20-30% blasts. The outcomes reported in AZA-001 included overall survival,TTP to AML and adverse events. No HRQoL results were reported; however,outcomes likely to impact on HRQoL were provided. The results showed that: the median overall survival was 24.5 months on aza,compared with 15.0 months in the CCR group (p = 0.0001); the response rates were low (complete remission 17% aza versus 8% CCR); the median time to transformation to AML was greater in the aza group (17.8 versus 11.5 months; p < 0.0001); and of patients who were red blood cell (RBC) transfusion-dependent at baseline,45% of those on aza became RBC transfusion-independent during the treatment period,compared with 11.8% in the CCR group (p < 0.0001). The ERG reran the submission's search strategies after some modifications incorporating minor improvements. The ERG analysed the submitted economic model (model 1) and identified a number of inconsistencies and errors within the model. The manufacturer submitted a revised model for analysis by the ERG. Using the issues identified in the earlier analysis,the ERG conducted those repairs to the revised model that were feasible within time constraints. The ERG ran this version in probabilistic sensitivity analyses to generate cost-effectiveness acceptability frontiers. The results of these exploratory analyses indicated that: for standard-dose chemotherapy (SDC)-treated patients,of six treatment options available,best supportive care (BSC) was likely the most cost-effective option up to a threshold of 51,000 pounds/quality-adjusted life-year (QALY) [beyond 51,000 pounds/QALY,aza + low-dose chemotherapy (LDC) became cost-effective]; for LDC-treated patients,of four options available,BSC was again the most cost-effective option up to a willingness-to-pay threshold of 51,000 pounds/QALY (aza + LDC became cost-effective after 51,000 pounds/QALY); for BSC-treated patients,aza + BSC became cost-effective relative to BSC at a threshold of about 52,000 pounds/QALY. The ERG considers these results exploratory and considers that they should be viewed with caution. The AZA-001 study showed that,compared with CCR,those MDS patients receiving aza had prolonged median survival,had delayed progression to AML,had reduced dependence on transfusions and had a small improvement in response rate. Given the general paucity of economic modelling work in MDS and the limitations of the submitted industry model there is an evident need for an independent cost-effectiveness analysis of aza in MDS. At the time of writing,the guidance appraisal consultation document issued by NICE on 4 March 2010 states that azacitidine is not recommended as a treatment option for people not eligible for haemopoietic stem cell transplantation with the the following conditions: intermediate-2 and high-risk MDS according to the International Prognostic Scoring System,CMML with 10-29% marrow blasts without myeloproliferative disorder,or with AML with 20-30% blasts and multilineage dysplasia,according to World Health Organization classification.",null,"UK",2010,null,"Azacitidine",null,"General","Direct","RCT","UK","General",null,"Azacitidine","Direct","RCT",null,"2010:2014"]
[24,"Eid,K. A.,et al. (2003). \"The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil.\" Braz J Med Biol Res 36(3): 315-321.",null,"Eid,K. A.,et al.","The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil","The feasibility of allogeneic bone marrow transplantation (alloBMT) in a developing country has not yet been demonstrated. Many adverse factors including social and economic limitations may reduce the overall results of this complex and expensive procedure. Our objective was to characterize the most important clinical,social and economic features of candidates for transplantation and their potential donors as well as the influence of these factors on overall survival in a retrospective and exploratory analysis at a university hospital. From July 1993 to July 2001,candidates for BMT were referred to the Bone Marrow Transplantation Unit by Hematology and Oncology Centers from several regions of Brazil. A total of 1138 patients were referred to us as candidates for alloBMT. Median age was 25 years (range: 2 months-60 years),684 (60.1%) were males and 454 (39.9%) were females. The clinical indications were severe aplastic anemia and hematological malignancies. From the total of 1138 patients,923 had HLA-typing; 497/923 (53.8%) candidates had full match donors; 352/1138 (30.8%) were eligible for alloBMT. Only 235 of 352 (66.7%) were transplanted. Schooling was 1st to 8th grade for 123/235 (52.3%); monthly family income ranged from US$60 (7%) to more than US$400 (36%). Overall survival for patients with chronic myeloid leukemia,severe aplastic anemia and acute myeloid leukemia was 58,60 and 30%,respectively. Thus,overall survival rates for the most frequent hematological diseases were similar to those reported in the International Registry,except for acute myeloid leukemia. This descriptive and exploratory analysis suggests the feasibility of alloBMT in a developing country like Brazil.",null,"Brazil",2003,null,"Stem Cell Therapy",null,"General","Unknown","Retrospective Analysis","Brazil","General",null,"Stem Cell Therapy","Unknown","Retrospective Analysis",null,"2000:2004"]
[25,"Flores,A.,et al. (1996). \"Use of all-trans retinoic acid to treat acute promyelocytic leukemia: a case with very severe features at the onset in Nicaragua.\" Med Pediatr Oncol 26(4): 258-260.",null,"Flores,A.,et al.","Use of all-trans retinoic acid to treat acute promyelocytic leukemia: a case with very severe features at the onset in Nicaragua","We observed a child with acute promyelocytic leukemia (APL) who,at the onset,had extremely severe hemorrhagic and septic complications. According to our experience in Nicaragua,there was a very high risk of early death. The patient was successfully treated with a program that included all-trans retinoic acid (ATRA) followed by cytotoxic chemotherapy. ATRA has two important features: it is effective in initial treatment of APL and it is inexpensive. Because of the high cost and the need for extensive supportive care,optimal myeloablative therapy used in patients with various types of acute myeloid leukemia generally cannot be given in developing countries. ATRA treatment for APL is affordable everywhere.",null,"Nicaragua",1996,null,"Various,Conventional Chemo",null,"Children","Unknown","Case Study","Nicaragua","Children",null,"Various,Conventional Chemo","Unknown","Case Study",null,"1960:1999"]
[26,"Glimelius,B.,et al. (2001). \"The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of chemotherapy effects in some major tumour types--summary and conclusions.\" Acta Oncol 40(2-3): 135-154.",null,"Glimelius,B.,et al.","The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of chemotherapy effects in some major tumour types--summary and conclusions","This report by The Swedish Council on Technology Assessment in Health Care (SBU) reviews,classifies,and grades the scientific literature on cancer chemotherapy in some major tumour types,describes the practice of chemotherapy in Sweden,compares practice with scientific knowledge,and analyses the costs and cost-effectiveness of chemotherapy. The report is intended primarily for decision-makers at various levels,both practitioners and administrators. It is also of interest for the medical profession. The extensive body of scientific literature was reviewed according to strict criteria that reflected the scientific weight of the literature. Sixteen experts representing different disciplines (oncology,surgery,internal medicine,health economy and quality of life research) participated in the literature review. Each section was discussed within the project group and was reviewed by at least one,but usually two international researchers. Additional input was provided by national experts representing different scientific disciplines. For the final evaluation to be as close to the objective truth as possible,a concerted effort was made to guarantee objectivity and thorough assessment of current knowledge about the effects of chemotherapy on the selected cancers. The tumour types selected for this assessment include firstly those types where three investigations had shown an increased use of chemotherapy in Sweden during the latest decade. These were non-small cell lung cancer (NSCLC),gastric cancer,pancreatic cancer,colorectal cancer and urinary bladder cancer. Secondly,the two tumour types comprising the greatest number of patients treated with chemotherapy in Sweden,breast cancer and haematological malignancies,were included. Among the haematological malignancies,the most prevalent ones,acute myeloid leukaemia (AML),chronic lymphocytic leukaemia (CLL),Hodgkin's disease (HD),aggressive non-Hodgkin's lymphoma (NHL) of the large B-cell type and indolent NHL of follicular type were evaluated. These constitute about 75%,of all haematological malignancies. Thirdly,ovarian cancer was included since chemotherapy has been extensively used and since,at the time of the planning of this overview,a group of very expensive drugs,the taxanes,had preliminarily shown promising results. A wealth of scientific literature has been published on cancer therapy. The review presented in this report is limited to scientific studies judged to be important for evaluating chemotherapy efficacy. Assessments of the content and quality of these studies,and a critical summary of the results in all stages of the selected tumours,have never before been attempted in this way. However,similar comprehensive overviews of certain stages of the tumours have previously been made. These overviews were also critically evaluated. Totally 1,496 studies involving 558,743 patients were reviewed. The survey of practice of chemotherapy use involved all departments of surgery,urology,gynaecology,internal medicine including haematologic units,pulmonary medicine and general and gynaecologic oncology at 16 hospitals in two health care regions in Sweden,covering 39% of the Swedish population. During the 4 weeks of the survey,all patients with the diagnoses concerned who received chemotherapy were registered. The study included 1,590 patients. The working group's general conclusions are summarised in the following points: The literature on the effects of chemotherapy is extensive. Chemotherapy has a well-documented role in the curative and palliative treatment of patients with several types of cancer. The use of chemotherapy is of utmost importance for the possibility of cure in certain tumour types. In other tumours,chemotherapy increases the possibility of cure when added to local and regional treatments,particularly surgery. In the instances of no possibility of cure,chemotherapy may to a variable extent improve both patient survival and well-being. In Sweden chemotherapy is largely used in accordance with that documented in the scientific literature. The extent of both over- and under-treatment seems to be limited but cannot be excluded at the individual patient level. The literature-based knowledge is scientifically of lower quality in the most chemotherapy sensitive tumours than in tumours showing more limited sensitivity. In the more sensitive tumours,positive effects on a symptomatic stage and survival were seen several decades ago. In those days,clinical treatment studies did not fulfil the current high quality requirements. Small life-prolonging effects of chemotherapy are sometimes very well documented in large,high quality scientific studies. Some of these s",null,"Sweden",2001,null,"Conventional Chemo",null,"General","Direct","Systematic Review","Sweden","General",null,"Conventional Chemo","Direct","Systematic Review",null,"2000:2004"]
[27,"Greiner,R. A.,et al. (2010). \"Cost-effectiveness of posaconazole compared with standard azole therapy for prevention of invasive fungal infections in patients at high risk in Switzerland.\" Oncology 78(3-4): 172-180.",null,"Greiner,R. A.,et al.","Cost-effectiveness of posaconazole compared with standard azole therapy for prevention of invasive fungal infections in patients at high risk in Switzerland","OBJECTIVE: To evaluate the cost-effectiveness of posaconazole versus standard azoles in the prevention of invasive fungal infection (IFI) in high-risk patients,using a pharmacoeconomic model that was adapted to a Swiss setting. METHODS: Decision tree models based on the results of two registration trials and subsequent Markov models over patient lifetimes were developed for patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) with neutropenia and for hematopoietic stem cell transplant recipients with graft-versus-host disease (GVHD). RESULTS: By reducing IFIs in AML/MDS patients with posaconazole prophylaxis,the contained IFI-related treatment costs more than compensated for the incremental cost of posaconazole,resulting in savings of CHF 1,118 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.16 life years saved per patient compared with fluconazole/itraconazole. In patients with GVHD,posaconazole prophylaxis prevented 0.04 IFIs,resulting in incremental costs of CHF 7,040 per patient. Lifetime posaconazole prophylaxis resulted in a benefit of 0.15 life years saved per patient,with an incremental cost-effectiveness rate of CHF 48,324 per life year saved. CONCLUSIONS: Given the conditions of the Swiss setting,posaconazole can be considered a cost-effective early treatment strategy that increases survival in patients at risk for IFI and may have a substantial benefit for the economic burden of IFI.",null,"Germany",2010,null,"Antifungal",null,"General","Direct","Clinical trial","Germany","General",null,"Antifungal","Direct","Clinical trial",null,"2010:2014"]
[28,"Heng,S. C.,et al. (2013). \"Pharmacoeconomic evaluation of fluconazole,posaconazole and voriconazole for antifungal prophylaxis in patients with acute myeloid leukaemia undergoing first consolidation chemotherapy.\" J Antimicrob Chemother 68(7): 1669-1678.",null,"Heng,S. C.,et al.","Pharmacoeconomic evaluation of fluconazole,posaconazole and voriconazole for antifungal prophylaxis in patients with acute myeloid leukaemia undergoing first consolidation chemotherapy","BACKGROUND: Fluconazole,posaconazole and voriconazole are used prophylactically in patients with acute myeloid leukaemia (AML). This study evaluated the clinical and economic outcomes of these agents when used in AML patients undergoing consolidation chemotherapy. METHODS: A retrospective chart review (2003-10) of AML patients receiving consolidation chemotherapy was performed. Patients were followed through their first cycle of consolidation chemotherapy. Antifungal prescribing patterns,clinical outcomes and resource consumptions were recorded. A decision analytical model was developed to depict the downstream consequences of using each antifungal agent,with success defined as completion of the designated course of initial antifungal prophylaxis without developing invasive fungal disease (IFD). Cost-effectiveness and sensitivity analyses were performed. RESULTS: A total of 106 consecutive patients were analysed. Baseline characteristics and predisposing factors for IFD were comparable between groups. Three IFDs (one proven,one probable and one suspected) occurred,all in the posaconazole group. Patients receiving posaconazole had the highest rate of intolerance requiring drug cessation (13% versus 7% in each of the fluconazole and voriconazole groups). Fluconazole conferred overall savings per patient of 26% over posaconazole and 13% over voriconazole. Monte Carlo simulation demonstrated a mean cost saving with fluconazole of AU$8430 per patient (95% CI AU$5803-AU$11 054) versus posaconazole and AU$3681 per patient (95% CI AU$990-AU$6319) versus voriconazole. One-way sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: This is the first study to show that,in the setting of consolidation therapy for AML,fluconazole is the most cost-effective approach to antifungal prophylaxis compared with posaconazole or voriconazole.",null,"Australia",2013,null,"Antifungal",null,"General","Direct","Retrospective Review,Decision Analytic Model","Australia","General",null,"Antifungal","Direct","Retrospective Review,Decision Analytic Model",null,"2010:2014"]
[29,"Horster,L.,et al. (2017). \"Cost-effectiveness of methods in personalized medicine. Results of a decision-analytic model in patients with acute myeloid leukemia with normal karyotype.\" Leuk Res 62: 84-90.",null,"Horster,L.,et al.","Cost-effectiveness of methods in personalized medicine. Results of a decision-analytic model in patients with acute myeloid leukemia with normal karyotype","BACKGROUND: During the last years,molecular genetic data are increasingly used as prognostic and predictive factors in acute myeloid leukemia (AML). The molecular genetic profile permits a rapid risk categorization and beyond that a prediction of differential treatment efficacy of post-remission chemotherapy versus an allogeneic hematopoietic cell transplantation (HCT) in specific subgroups. METHODS: The aim of this study was to evaluate cost-effectiveness of two different strategies of risk categorization (conventional cytogenetic diagnostics (CCD) versus molecular genetic diagnostics (MGD)) in patients with AML,using a decision-analytic state-transition model. The model is run as (Monte Carlo) microsimulation in which individuals pass through in cycles with a cycle length of one month and a time horizon of ten years. FINDINGS: Results show that on average,individuals within the MGD group generated about US$ 32,000 higher costs but survived about seven months longer than individuals within the CCD group. This leads to an Incremental Cost-Effectiveness Ratio (ICER) of about US$ 4928 per survived month. INTERPRETATION: With a GDP (Gross Domestic Product) of US$ 26,467 (euro 33,630) per capita in Germany in 2012,the base-case ICER of US$ 4928 per survived month projected to US$ 59,136 per survived year is in between the simple GDP and the three times GDP per capita.",null,"Germany",2017,null,"Diagnostics",null,"General","Direct,Indirect","Decision Analytic Model","Germany","General",null,"Diagnostics","Direct,Indirect","Decision Analytic Model",null,"2015:2018"]
[30,"Huang,B. T.,et al. (2011). \"Analysis of efficacy and cost-effectiveness of high-dose arabinoside versus daunorubicin chemotherapy in older adult patients with acute myeloid leukemia by cytogenetic risk profile: retrospective review from China.\" Int J Hematol 93(4): 474-481.",null,"Huang,B. T.,et al.","Analysis of efficacy and cost-effectiveness of high-dose arabinoside versus daunorubicin chemotherapy in older adult patients with acute myeloid leukemia by cytogenetic risk profile: retrospective review from China","High-dose arabinoside (HiDAC) and daunorubicin (DNR)-based chemotherapy are the primary consolidation treatment options for older adults (50-60 years old) with acute myeloid leukemia in China. We analyzed the event-free survival (EFS) and hospital treatment charges of older adult patients with different cytogenetic risk profiles. In patients with a better/intermediate risk profile,the average total treatment cost of HiDAC was similar to that of DNR (P = 0.11). A 5-year follow-up of patients with better/intermediate cytogenetic risk profiles revealed that the median EFS of patients who received HiDAC was significantly longer than for patients who received the DNR-based regimen (27 vs. 20 months,P = 0.03). Average cost per year of life saved was 18,746.84 USD for HiDAC,compared to 32,733.37 USD for DNR. In contrast,for patients with a poor cytogenetic risk profile,the average total treatment cost for HiDAC was higher than for DNR (P < 0.005). In addition,the median EFS in the HiDAC protocol group was significantly lower than in the DNR group (11 vs. 20 months,P = 0.003). Meanwhile,in this risk group,the average cost per year of life saved was 103,237.70 USD compared to 32,277.93 USD,respectively,in the HiDAC and DNR regimens. We conclude that HiDAC is a more efficacious and cost-effective consolidation treatment regimen in the better/intermediate risk group,while the DNR-based regimen is more cost-effective in the poor risk group.",null,"China",2011,null,"Conventional Chemo",null,"Elderly","Direct","Retrospective Review","China","Elderly",null,"Conventional Chemo","Direct","Retrospective Review",null,"2010:2014"]
[31,"Imataki,O.,et al. (2010). \"Cost and effectiveness of reduced-intensity and conventional allogeneic hematopoietic stem cell transplantation for acute myelogenous leukemia and myelodysplastic syndrome.\" Support Care Cancer 18(12): 1565-1569.",null,"Imataki,O.,et al.","Cost and effectiveness of reduced-intensity and conventional allogeneic hematopoietic stem cell transplantation for acute myelogenous leukemia and myelodysplastic syndrome","GOALS OF WORK: Allogeneic stem cell transplantation with a reduced-intensity regimen (RIST) has been evaluated mostly in terms of its clinical benefit,and the pharmacoeconomic aspects of this procedure remain unclear. We compared the cost and effectiveness of RIST with those of stem cell transplantation using a conventional myeloablative regimen (CST). PATIENTS AND METHODS: Fifty consecutive patients who underwent transplantation for myeloid malignancy were included. Life years and medical costs during the entire treatment course for up to 2 years after transplantation were evaluated,and cost-effectiveness was assessed from the payer's perspective. MAIN RESULTS: Of these 50 cases,35 were treated with CST and 15 were treated with RIST. The mean survival time was 1.5 years in CST and 1.2 years in RIST,while the mean total cost per patient within the first 2 years was $29,630 for CST and $29,466 for RIST,with no significant difference. The duration of total hospitalization was shorter in RIST than in CST; then,the cost for hospitalization represented a lower proportion of the total cost in RIST (49% of total cost) than in CST (63%). In contrast,the cost related to the conditioning regimen was significantly higher in RIST than in CST. CONCLUSIONS: This result suggests that the increased cost of the conditioning regimen offsets the reduced cost of hospitalization in RIST. Although some differences were observed in the details of the cost,the total cost and mean survival were comparable between CST and RIST,and this result was confirmed by a probabilistic sensitivity analysis.",null,"Japan",2010,null,"Conventional Chemo,Stem Cell Therapy",null,"General","Direct","Cohort Study","Japan","General",null,"Conventional Chemo,Stem Cell Therapy","Direct","Cohort Study",null,"2010:2014"]
[32,"Inaba,H.,et al. (2011). \"Randomized trial of 2 dosages of prophylactic granulocyte-colony-stimulating factor after induction chemotherapy in pediatric acute myeloid leukemia.\" Cancer 117(6): 1313-1320.",null,"Inaba,H.,et al.","Randomized trial of 2 dosages of prophylactic granulocyte-colony-stimulating factor after induction chemotherapy in pediatric acute myeloid leukemia","BACKGROUND: Granulocyte-colony-stimulating factor (G-CSF) is effective in accelerating neutrophil recovery after intensive chemotherapy for acute myeloid leukemia (AML). However,the optimal G-CSF dosage for patients with AML has not been determined. To the authors' knowledge,G-CSF dosages have not been compared in a randomized AML study. METHODS: Patients who were enrolled on the St. Jude AML97 protocol and remained on study after window therapy were eligible to participate. The effect of the dosage of G-CSF given after induction chemotherapy Courses 1 and 2 was analyzed in 46 patients who were assigned randomly in a double-blinded manner to receive either 5 mug/kg daily or 10 mug/kg daily of G-CSF. The number of days of G-CSF treatment,neutropenia (an absolute neutrophil count <0.5 x 10(9) /L),and hospitalization; the number of episodes of febrile neutropenia,grade 2 through 4 infection,and antimicrobial therapy; transfusion requirements; the cost of supportive care; and survival were compared between the 2 study arms. RESULTS: No statistically significant differences were observed between the 2 arms in any of the endpoints measured. CONCLUSIONS: The higher G-CSF dosage (10 mug/kg daily) offered no greater benefit than the lower dosage (5 mug/kg daily) in patients who were receiving intensive chemotherapy for AML.",null,"USA",2011,null,"CSF",null,"General","Resource Use","Cohort Study","USA","General",null,"CSF","Resource Use","Cohort Study",null,"2010:2014"]
[33,"Irish,W.,et al. (2017). \"Acute myeloid leukemia: a retrospective claims analysis of resource utilization and expenditures for newly diagnosed patients from first-line induction to remission and relapse.\" Curr Med Res Opin 33(3): 519-527.",null,"Irish,W.,et al.","Acute myeloid leukemia: a retrospective claims analysis of resource utilization and expenditures for newly diagnosed patients from first-line induction to remission and relapse","OBJECTIVE: The objective of this study was to estimate resource utilization and expenditures for patients with acute myeloid leukemia (AML) in a real-world claims database. RESEARCH DESIGN AND METHODS: AML patients were identified in MarketScan claims databases between 1 January 2009 and 31 January 2015. Patients had a minimum of two AML diagnosis codes,hospitalization within 14 days after initial diagnosis,and >/=6 months of enrollment before initial diagnosis. Patients were monitored from first-line induction to a record of remission. A subset had a record of a second treatment period,defined as time from relapse to remission. Patient demographics,AML risk factors,and comorbidities were recorded. Descriptive analysis of utilization and expenditures (in 2014 $US) were reported for each cohort. RESULTS: The inclusion criteria were met in 1597 patients (mean age,58.4 years; 51.0% male). Ninety percent of patients had >/=1 risk factor for AML. Mean (SD) healthcare expenditures for patients from first-line induction to remission (n = 681) were $208,857 ($152,090). Of the 157 who had a record of relapse,70 had a record of a second remission. Expenditures for these patients (n = 70) from relapse to remission were $142,569 ($208,307); 60% were admitted to a hospital for a mean of 18.5 hospital days,and 20% had >/=1 emergency room visit. CONCLUSIONS: Although this claims-based analysis is limited by a lack of generalizability to noninsured populations and potential underreporting of certain events and diagnoses,we found that treating AML patients poses a significant healthcare burden,during both first-line induction and relapse. With people living longer,the number of cases of AML is expected to increase in the future.",null,"USA",2017,null,"Unknown",null,"Elderly","Resource Use","Retrospective Analysis","USA","Elderly",null,"Unknown","Resource Use","Retrospective Analysis",null,"2015:2018"]
[34,"Jiang,H.,et al. (2015). \"Reduced medical costs and hospital days when using oral arsenic plus ATRA as the first-line treatment of acute promyelocytic leukemia.\" Leuk Res 39(12): 1319-1324.",null,"Jiang,H.,et al.","Reduced medical costs and hospital days when using oral arsenic plus ATRA as the first-line treatment of acute promyelocytic leukemia","We have demonstrated that oral arsenic (Realgar-Indigo naturalis formula,RIF) plus all-trans retinoic acid (ATRA) is not inferior to intravenous arsenic trioxide (ATO) plus ATRA as the first-line treatment of acute promyelocytic leukemia (APL). To compare the cost-effectiveness of oral and intravenous arsenic,we analyzed the results of 30 patients in each group involved in a randomized controlled trial at our center. The median total medical costs were $13,183.49 in the RIF group compared with $24136.98 in the ATO group (p<0.0001). This difference primarily resulted from the different costs of induction therapy (p=0.016) and maintenance treatment (p<0.0001). The length of hospitalization for the RIF group was significantly lower than that for the ATO group (24 vs. 31 days,p<0.0001) during induction therapy. During maintenance treatment,the estimated medical costs were $2047.14 for each patient in the RIF group treated at home compared with $11273.81 for each patient in the ATO group treated in an outpatient setting (p<0.0001). We conclude that oral RIF plus ATRA significantly reduced the medical costs and length of hospital stay during induction and remission therapy compared with ATO plus ATRA in APL patients.",null,"China",2015,null,"Various",null,"General","Direct","RCT","China","General",null,"Various","Direct","RCT",null,"2015:2018"]
[35,"Kaito, K., et al. (1998). \"Combination chemotherapy with G-CSF, M-CSF and EPO: successful treatment for acute myelogenous leukemia without blood transfusion at lower medical costs.\" Acta Haematol 100(1): 57-60.",null,"Kaito, K., et al.","Combination chemotherapy with G-CSF, M-CSF and EPO: successful treatment for acute myelogenous leukemia without blood transfusion at lower medical costs","A 55-year-old Jehova's Witness was treated for acute myelogenous leukemia (AML) by intensive chemotherapy with enocitabine, 6-mercaptopurine and daunorubicin. G-CSF, M-CSF and EPO were subsequently administered. Even though no blood transfusion was given for religious reasons, complete remission was achieved without serious infection and hemorrhage. The total cost for induction chemotherapy was less expensive than is the case for elderly AML patients. This case indicates that the administration of cytokines might reduce the incidence of infection and the necessity for blood products, which would result in favorable cost effectiveness for the treatment of elderly patients with AML.",null,"Japan",1998,null,"CSF,Conventional Chemo,Enocitabine",null,"Elderly","Direct","Case Study","Japan","Elderly",null,"CSF,Conventional Chemo,Enocitabine","Direct","Case Study",null,"1960:1999"]
[36,"Kasteng, F., et al. (2007). \"Economic evaluations of leukemia: a review of the literature.\" Int J Technol Assess Health Care 23(1): 43-53.",null,"Kasteng, F., et al.","Economic evaluations of leukemia: a review of the literature","OBJECTIVES: Leukemia, together with lymphoma and multiple myeloma, are hematological malignancies, malignancies of the blood-forming organs. There are four major types of leukemia: acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL). There is a growing amount of literature of the health economic aspects of leukemia. However, no comprehensive review is yet performed on the health economic evidence for the disease. Hence, our aim was to review and analyze the existing literature on economic evaluations of the different types of leukemia. METHODS: A systematic literature search used electronic databases to identify published cost analyses and economic evaluations of leukemia treatments. After reviewing all identified studies, sixty studies were considered relevant for the purpose of the review. RESULTS: The identified studies were published after 1990, with a few exceptions. Many of the identified economic evaluations in leukemia, particularly for ALL and AML, may be defined as cost-minimization analyses, where only the costs of different treatment strategies are compared. In CML, a new treatment, imatinib, was introduced in 2001 and several cost-effectiveness analyses have since then been conducted comparing imatinib with previous first line treatments. CONCLUSIONS: This review indicates that there is a shortage of cost-effectiveness information in leukemia. The introduction of new therapies will stress the need for new economic evaluations in this group of diseases. More information about the total costs, that is, including indirect costs, and quality of life effects would be valuable in future evaluations in leukemia.",null,"Sweden",2007,null,"Unknown",null,"Unknown","Direct,Indirect","Systematic Review","Sweden","Unknown",null,"Unknown","Direct,Indirect","Systematic Review",null,"2005:2009"]
[37,"Kruse, M., et al. (2015). \"Budgetary impact of treating acute promyelocytic leukemia patients with first-line arsenic trioxide and retinoic acid from an Italian payer perspective.\" PLoS One 10(8): e0134587.",null,"Kruse, M., et al.","Budgetary impact of treating acute promyelocytic leukemia patients with first-line arsenic trioxide and retinoic acid from an Italian payer perspective","The objective of this study was to estimate the net cost of arsenic trioxide (ATO) added to all-trans retinoic acid (ATRA) compared to ATRA plus chemotherapy when used in first-line acute promyelocytic leukemia (APL) treatment for low to intermediate risk patients from the perspective of the overall Italian healthcare systemA Markov model was developed with 3 health states: stable disease, disease event and death. Each month, patients could move from stable to disease event or die from either state. After a disease event, patients discontinued initial treatment and switched to the other regimen as second-line therapy. Treatment regimens, efficacy and adverse events were derived from published sources and expert opinion; unit costs were collected from standard Italian sources. Clinical outcomes and costs for pre-ATO and post-ATO scenarios were combined with population and product utilization information to calculate the total budgetary impact using a 3-year time horizon; one-way sensitivity analyses were conducted. Three-year cumulative pharmacy costs for ATO+ATRA were euro46,700 per-patient versus euro6,500 for ATRA+chemotherapy; however, medical costs for ATO+ATRA were euro12,300 per-patient versus euro30,200 for ATRA+chemotherapy. The total budgetary impact was estimated to be an additional euro127,300, euro312,500 and euro477,800 in the first, second and third years, respectively. The model was most sensitive to changes in the cost of the ATO+ATRA regimen during the consolidation phase. Budgetary impact models are valuable to payers making formulary decisions regarding the access and affordability of new medicines. The cost of treatment analysis showed that pharmacy costs for ATO+ATRA were higher than for ATRA+chemotherapy, while all other evaluated costs were lower for ATO+ATRA treated patients. The average budgetary impact was euro305,900 per year overall, representing a 3.5% increase. Further research is needed to determine the cost-effectiveness of ATO+ATRA compared to the current first-line standard of care in APL.",null,"USA,Germany,Italy,UK",2015,null,"Various,Conventional Chemo",null,"General","Direct","Cohort Study","USA,Germany,Italy,UK","General",null,"Various,Conventional Chemo","Direct","Cohort Study",null,"2015:2018"]
[38,"Kuse, R., et al. (2001). \"Which factors render cost-covering lump-sum charging difficult for the treatment of patients with acute leukemias?\" Onkologie 24(3): 292-294.",null,"Kuse, R., et al.","Which factors render cost-covering lump-sum charging difficult for the treatment of patients with acute leukemias?","BACKGROUND: Growing budget limitations and the planned charging subject to Diagnosis-Related Groups (DRG) points raise the question as to what costs are incurred by the induction therapy and early consolidation treatment of patients with acute myeloid leukemias (AML) and whether these can be compensated in a cost-covering manner by a system based on DRG points. PATIENTS AND METHODS: For 100 patients recruited within the framework of the \"Kooperative AML-Studie 96\" of the Suddeutsche Hamoblastosegruppe a process cost analysis was made between 1996 and 1999. All manpower and material costs incurred in the department itself and in the secondary services departments as well as the basic cost shares were recorded taking into due account the length of stay. The cost breakdown was effected based on a double induction therapy and one early consolidation treatment. RESULTS: It turns out that substantial differences exist between lower und upper limits of the length of stay and costs. For all three therapy blocks for patients up to 60 years the cost spread varies between 63 and 204 kDM with a median of 105 kDM, and for older patients between 55.6 and 146.6 kDM with a median of 87.6 kDM. On average, the costs subject to length of stay were roughly 70%. CONCLUSIONS: As the costs per case are subject to a spread and, for this relatively small group of patients, are extremely high, the fixing of a case-related lump sum is problematic, the more so as age of patient, comorbidity, type of therapy, ist outcome, and therapy-induced complications represent decisive influencing factors.",null,"Germany",2001,null,"Conventional Chemo",null,"General","Direct","Retrospective Analysis","Germany","General",null,"Conventional Chemo","Direct","Retrospective Analysis",null,"2000:2004"]
[39,"Lachaine, J., et al. (2015). \"Economic evaluation of arsenic trioxide compared to all-trans retinoic acid + conventional chemotherapy for treatment of relapsed acute promyelocytic leukemia in Canada.\" Eur J Haematol 95(3): 218-229.",null,"Lachaine, J., et al.","Economic evaluation of arsenic trioxide compared to all-trans retinoic acid + conventional chemotherapy for treatment of relapsed acute promyelocytic leukemia in Canada","OBJECTIVES: Acute promyelocytic leukemia (APL) is an uncommon type of acute leukemia characterized by high early mortality. Current first-line treatments include all-trans retinoic acid (ATRA), anthracyclines, and other conventional chemotherapies (CTs). Although APL is generally associated with a good prognosis, about 20% of patients who achieve remission subsequently relapse and are resistant to the previously administrated treatment. The objective of this study was to assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) compared to ATRA+CT for treatment of patients with relapsed/refractory APL. METHODS: The cost-effectiveness of ATO compared to ATRA+CT for treating patients with relapsed/refractory APL was assessed over a lifetime horizon using a Markov model. The model considers five health states: induction, second remission, treatment failure or relapse, postfailure, and death. Markov cycle length was 1 month for the first 24 months and 1 yr thereafter. The model also takes into account the incidence of grade 3-4 adverse events reported in clinical trials. Analyses were conducted from a Canadian Ministry of Health (MoH) and a societal perspective. RESULTS: Compared to ATRA+CT, ATO was associated with incremental cost-effectiveness ratios of $ 20,551/quality-adjusted life year (QALY) from a MoH perspective and $ 22,219/QALY from a societal perspective. Results of the probabilistic sensitivity analysis indicated that ATO is a cost-effective strategy in 99.27% and 98.98% of the simulations from a MoH and a societal perspective, respectively. CONCLUSIONS: This economic evaluation demonstrates that ATO is a cost-effective strategy compared to ATRA+CT for treatment of patients with relapsed/refractory APL in Canada.",null,"Canada",2015,null,"Various,Conventional Chemo",null,"General","Direct,Indirect","Cohort Study","Canada","General",null,"Various,Conventional Chemo","Direct,Indirect","Cohort Study",null,"2015:2018"]
[40,"Lachaine, J., et al. (2015). \"Economic evaluation of arsenic trioxide for treatment of newly diagnosed acute promyelocytic leukaemia in Canada.\" Hematol Oncol 33(4): 229-238.",null,"Lachaine, J., et al.","Economic evaluation of arsenic trioxide for treatment of newly diagnosed acute promyelocytic leukaemia in Canada","To assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) + all-trans retinoic acid (ATRA) for treating newly diagnosed acute promyelocytic leukaemia (APL), the cost-effectiveness of ATO + ATRA compared to ATRA + idarubicin (IDA) was assessed over a lifetime horizon using a time-dependent Markov model. The model considers four health states: complete remission, treatment failure or relapse, post-failure, and death. Markov cycle length was 1 month for the first 48 months and 1 year thereafter. Efficacy outcomes in terms of event-free survival and overall survival were taken from a head-to-head clinical trial. Costs were associated with drug and administration, adverse events (AEs), treatment of relapses, follow-up visits, and productivity losses. Utilities and disutilities associated with health states and AEs were derived from the literature. Compared to ATRA + IDA, ATRA + ATO is associated with incremental cost-effectiveness ratios (ICERs) of $CAD50,193/quality-adjusted life years (QALY) and $CAD50,338/QALY from a Canadian Ministry of Health (MoH) and societal perspectives, respectively. Results of the one-way sensitivity analysis show that ICER varied from $CAD23,045 to $CAD60,759/QALY (MoH perspective) and from $CAD23,120 to $CAD60,905/QALY (societal perspective). ATO in the first-line therapy for patients with APL can be considered a more cost-effective strategy than standard treatment from a Canadian perspective.",null,"Canada",2015,null,"Various,Conventional Chemo",null,"General","Direct","Cohort Study","Canada","General",null,"Various,Conventional Chemo","Direct","Cohort Study",null,"2015:2018"]
[41,"Leunis, A., et al. (2013). \"The costs of initial treatment for patients with acute myeloid leukemia in the Netherlands.\" Leuk Res 37(3): 245-250.",null,"Leunis, A., et al.","The costs of initial treatment for patients with acute myeloid leukemia in the Netherlands","The aim of this study was to calculate the costs of the current initial treatment of acute myeloid leukemia. Resource use was collected for 202 patients who started with intensive chemotherapy in 2008 or 2009. The costs of the first induction course were significantly higher than the costs of the second induction course. Allogeneic transplantation from a matched unrelated donor was significantly more expensive than the other consolidation treatments. In-hospital stay was the major cost driver in the treatment of AML. Research regarding possibilities of achieving the same or better health outcome with lower costs is warranted.",null,"The Netherlands",2013,null,"Unknown",null,"General","Resource Use","Retrospective Analysis","The Netherlands","General",null,"Unknown","Resource Use","Retrospective Analysis",null,"2010:2014"]
[42,"Luo, X. Q., et al. (2009). \"Improved outcome for Chinese children with acute promyelocytic leukemia: a comparison of two protocols.\" Pediatr Blood Cancer 53(3): 325-328.",null,"Luo, X. Q., et al.","Improved outcome for Chinese children with acute promyelocytic leukemia: a comparison of two protocols","OBJECTIVE: Acute promyelocytic leukemia (APL) is now highly curable, except in many developing countries. Introduction of current treatment strategies may improve the outcome for children with APL in these countries. METHODS: The diagnosis was based on the FAB classification and detection of PML-RAR alpha rearrangement. From December 1999 to September 2004, 16 eligible children were treated with an intensive in-house protocol including high-dose AraC and anthracycline. Subsequently, 14 cases were treated with a less intensive protocol modified from the PETHEMA LPA99. RESULTS: The 3.5 years event-free survival (EFS) was 37.5% (95% CI, 13.8-61.2%) for patients treated on initial protocol. The treatment failures were: six patients abandoned treatment (37.5%), two who died of intracranial hemorrhage at diagnosis (6.3%) and sepsis in remission (6.3%) respectively, and two who relapsed (12.5%). Those treated on modified PETHEMA had a 3.5 years EFS of 79.6% (95% CI, 52.9-106.3%). Treatment failures included: one who died of intracranial hemorrhage at diagnosis (7.1%) and one who relapsed (7.1%). The patients on modified PETHEMA had a significantly higher EFS (P = 0.012), lower frequency of sepsis during treatment (7.7% vs. 77.8%; P = 0.0015), and lower hospitalization cost (median US$ 4,700 vs. US$ 20,000; P < 0.0001) than those on in-house protocol. CONCLUSION: Treatment with the less intensive protocol based on the PETHEMA LPA99 study of childhood APL successfully reduced chemotherapy toxicity and lowered hospitalization costs without increasing relapses. This led to decreases in treatment-related morbidity and the treatment abandonment rate, thus improving overall outcome.",null,"China",2009,null,"Conventional Chemo",null,"Children","Direct","Cohort Study","China","Children",null,"Conventional Chemo","Direct","Cohort Study",null,"2005:2009"]
[43,"Marie, J. P., et al. (1992). \"Cost of complete remission induction in acute myeloblastic leukemia: evaluation of the cost-effectiveness of a new drug.\" Leukemia 6(7): 720-722.",null,"Marie, J. P., et al.","Cost of complete remission induction in acute myeloblastic leukemia: evaluation of the cost-effectiveness of a new drug","The use of new drugs in the treatment of AML could dramatically increase the cost of induction chemotherapy. To evaluate the cost-effectiveness of such new drugs, the overall cost to achieve complete remission (CR) with treatments including these drugs has to be compared to the cost of the daunorubicin-cytosine arabinoside (DNR-AraC) association, considered as the reference treatment. A retrospective analysis of charts from 15 patients treated with DNR-AraC was used to identify 228 items of cost, including general cost, diagnostic, supportive care, and chemotherapy. Eleven patients underwent CR after one course of chemotherapy for a cost of US$16,701 +/- 4451, and four patients achieved CR after two courses for a cost of US$37,130 +/- 4923. The chemotherapy represented only 1.4% of the total cost, supportive care 25% and general cost 56%. According to these data, the projective cost of a treatment with mitoxantrone instead of DNR was simulated in 40 untreated patients with AML. The better rate of CR obtained after one course of chemotherapy leads to a saving of 9% (US$1261) per patient, despite the higher cost of chemotherapy. Cost-effectiveness evaluation should be included in the clinical study of trials with new drugs.",null,"France",1992,null,"Conventional Chemo",null,"General","Direct,Indirect","Retrospective Analysis","France","General",null,"Conventional Chemo","Direct,Indirect","Retrospective Analysis",null,"1960:1999"]
[44,"Menzin, J., et al. (2002). \"The outcomes and costs of acute myeloid leukemia among the elderly.\" Arch Intern Med 162(14): 1597-1603.",null,"Menzin, J., et al.","The outcomes and costs of acute myeloid leukemia among the elderly","BACKGROUND: The incidence of acute myeloid leukemia (AML) among the elderly can be expected to grow as the population continues to age. However, data on current treatment practices and costs for this form of cancer are sparse. METHODS: We used a retrospective inception cohort design and data from a linkage between 11 Surveillance, Epidemiology, and End Results cancer registries and Medicare administrative claims. We evaluated survival, use of health care resources, use of chemotherapy, and Medicare payments among adults 65 years and older with an initial diagnosis of AML between January 1, 1991, and December 31, 1996. RESULTS: A total of 2657 elderly patients with AML and complete Medicare claims data were identified. The prognosis for these patients was poor, with median survival estimated to be 2 months and a 2-year survival rate of 6%. Mean +/- SE total Medicare payments were $41,594 +/- $870 (in 1998 US dollars), 84% of which was attributed to inpatient payments. In the 2 years after the AML diagnosis, 790 patients (30%) underwent chemotherapy treatment. These patients had costs almost 3 times higher than those of other patients, and their median survival was 6 months longer. The use of hospice care was rare (17% of patients). CONCLUSIONS: Among the elderly, AML is associated with a poor prognosis and substantial costs during the relatively few remaining months of life. Moreover, most patients do not receive active treatment with chemotherapy or hospice services. Further work is needed to characterize this disease and the patient-related factors that influence treatment decisions and associated health outcomes.",null,"USA",2002,null,"Conventional Chemo",null,"Elderly","Direct,Resource use","Retrospective Review","USA","Elderly",null,"Conventional Chemo","Direct,Resource Use","Retrospective Review",null,"2000:2004"]
[45,"Meyers, J., et al. (2013). \"Medicare fee-for-service enrollees with primary acute myeloid leukemia: an analysis of treatment patterns, survival, and healthcare resource utilization and costs.\" Appl Health Econ Health Policy 11(3): 275-286.",null,"Meyers, J., et al.","Medicare fee-for-service enrollees with primary acute myeloid leukemia: an analysis of treatment patterns, survival, and healthcare resource utilization and costs","BACKGROUND: Acute myeloid leukemia (AML) is the most common form of acute leukemia affecting adults, with incidence increasing with patient age. Previous studies have found that older AML patients, constituting the majority of the AML population, generally have poor outcomes, high healthcare expenditures, and median survival of <3 months. Because up-to-date information on treatment patterns, survival trends, and costs of care for elderly AML patients are lacking in the literature, we examined Medicare fee-for-service enrollees with primary AML to update these estimates and report on changes in treatment for this population. OBJECTIVE: The primary objective of this study was to examine real-world data on treatment patterns, survival, and costs in elderly patients with primary AML. Factors associated with receipt of chemotherapy and with mortality also were assessed. METHODS: This is a retrospective database analysis using the Surveillance, Epidemiology, and End Results cancer registry and linked Medicare claims. Patients aged 65 years and older, who were newly diagnosed with AML between 1 January 1997 and 31 December 2007 were selected if they had no previous neoplasm or hematological disease. Patients were followed until death or to the end of the observation period (31 December 2007). Study measures included chemotherapy and supportive care (SC) received, survival time, and all-cause healthcare utilization and costs accrued from AML diagnosis until death or observation period end. Regression analyses assessed factors associated with receipt of chemotherapy (logistic) and mortality among chemotherapy and SC users (Cox). RESULTS: Of the 4,058 patients meeting the inclusion criteria, 43 % received chemotherapy; 57 % received SC only. Among patients receiving chemotherapy, 69.1 % died within 1 year; median survival was 7.0 months. Among patients receiving only SC, 95.0 % died within 1 year; median survival was 1.5 months. The most significant factors associated with receipt of chemotherapy were patient age [odds ratio (OR) = 0.420 among patients 75-84 years and 0.099 among patients 85+ years, compared with patients aged 65-74 years) and Charlson Comorbidity Index (CCI) score (OR = 0.614 for patients with a CCI = 2 or 3 and 0.707 for patients with a CCI >3, compared with patients with a CCI = 0) (all P < 0.001). The most significant factors associated with mortality among patients receiving chemotherapy were patient age [hazard ratio (HR) = 1.321 among patients 75-84 years and 1.832 among patients 85+ years, compared with patients aged 65-74 years] and CCI score (OR = 1.287 for patients with a CCI = 2 or 3 and 1.220 for patients with a CCI >3, compared with patients with a CCI = 0) (all P < 0.01). Mean (standard deviation) all-cause healthcare costs were $96,078 ($109,072); the largest component was inpatient utilization (76.3 %). CONCLUSIONS: Younger patients with fewer comorbidities were more likely to receive chemotherapy and had longer survival. AML is associated with a substantial economic burden, and treatment outcomes appear to be suboptimal, with limited therapy options currently available.",null,"USA",2013,null,"Conventional Chemo,Supportive Care",null,"Elderly","Resource Use,Direct,Indirect","Retrospective Analysis","USA","Elderly",null,"Conventional Chemo,Supportive Care","Resource Use,Direct,Indirect","Retrospective Analysis",null,"2010:2014"]
[46,"Michallet, M., et al. (2013). \"Prospective study of erythropoietin use on quality of life and cost effectiveness in acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation patients.\" Cancer 119(1): 107-114.",null,"Michallet, M., et al.","Prospective study of erythropoietin use on quality of life and cost effectiveness in acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation patients","BACKGROUND: Despite frequent anemia and multiple transfusions in patients undergoing chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia , recommendations for use of erythropoiesis-stimulating agents (ESAs) in these populations are still missing. The primary objective was the effect of ESA administration on patient's quality of life (QoL). Secondary objectives were hemoglobin (Hb) recovery, red blood cell (RBC) transfusions, overall survival, and event-free survival. METHODS: Adult patients with Hb </= 11 g/dL after consolidation chemotherapy for acute myeloid leukemia (group 1), or after allo-HSCT for any hematological diseases (group 2), were prospectively included. ESA was administered subcutaneously once per week during a maximum period of 6 months and was stopped when Hb level reached 12 g/dL. A paired-matched analysis using a historical control group was performed for secondary endpoints. Fifty-two patients were included in group 1, and 55 patients were in group 2. RESULTS: For the global population, a significant improvement of QoL was noticed with ESA use; 83% (group 1) and 71% (group 2) of patients achieved an Hb level >/= 12 g/dL without transfusion requirement. The pair-matched analysis showed a reduction of 4 RBC units per patient in group 1 (P = .0002) and 3 RBC units per patient in group 2 (P = .04). No significant difference in terms of thromboembolic events, overall survival, and event-free survival was observed between ESA and control groups. A RBC transfusion median savings of euro1712 per patient was estimated in each group. CONCLUSIONS: ESAs have a clinical and economic benefit on Hb recovery, could improve a patient's QoL, and lead to a significant reduction in number of RBC transfusions with no effect on survival.",null,"France",2013,null,"CSF",null,"Adults","Direct","Cohort Study","France","Adults",null,"CSF","Direct","Cohort Study",null,"2010:2014"]
[47,"Mishra, V., et al. (2001). \"A prospective cost evaluation related to allogeneic haemopoietic stem cell transplantation including pretransplant procedures, transplantation and 1 year follow-up procedures.\" Bone Marrow Transplant 28(12): 1111-1116.",null,"Mishra, V., et al.","A prospective cost evaluation related to allogeneic haemopoietic stem cell transplantation including pretransplant procedures, transplantation and 1 year follow-up procedures","The Norwegian Ministry of Health and Social Affairs recently introduced activity-based financing for hospitals partly based on diagnosis-related groups (DRG). We soon observed that there seemed to be a considerable discrepancy between the reimbursement amount and the real cost of allogeneic haemopoietic stem cell transplantation. It was therefore decided to undertake a prospective micro-cost analysis to define a more realistic reimbursement. To identify real costs, we undertook a registration of pre-transplant procedures, transplantation and 1 year follow-up costs, including harvesting, personnel costs, clinical and laboratory procedures, together with blood products and drugs related to patients and donors. These data were compared to hospital DRG reimbursement. This information was registered for 17 consecutive patients, with a mean age 40 years (range 17-58 years). Ten patients had chronic myeloid leukaemia, three had acute lymphatic leukaemia, two had acute myeloid leukaemia and two had myelodysplastic syndrome. The data analysis showed a mean cost of US$ 106825 (NOK 901982), (range US$ 42376-362430). The average actual hospital revenue (50% DRG reimbursement + income related to length of stay + special procedure funding) was US$ 36404 (range US$ 26228-55998). Activity-based financing as applied in Norway, under-compensates hospital costs for allogeneic bone marrow transplantation. The government should make realistic estimates of real costs before introducing financial reforms in the health care system.",null,"Norway",2001,null,"Stem Cell Therapy",null,"General","Direct","Cohort Study","Norway","General",null,"Stem Cell Therapy","Direct","Cohort Study",null,"2000:2004"]
[48,"Ngamkiatphaisan, S., et al. (2007). \"Cost analysis of hematopoietic stem cell transplantation in adult patients with acute myeloid leukemia at King Chulalongkorn Memorial Hospital.\" J Med Assoc Thai 90(12): 2565-2573.",null,"Ngamkiatphaisan, S., et al.","Cost analysis of hematopoietic stem cell transplantation in adult patients with acute myeloid leukemia at King Chulalongkorn Memorial Hospital","The purpose of the study was to analyze the first-year cost ofhematopoietic stem cell transplantation (HSCT) program for the treatment of adult patients with acute myeloid leukemia (AML) at King Chulalongkorn Memorial Hospital (KCMH). The present retrospective study was carried out on 67 AML patients treated with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) at KCMH during the period of 1994 to 2005. The actual total one-year cost from the provider perspective were determined by the reviewing medical records for medical care costs (MCCs) and by adjusting data from the reports of annual cost analysis of KCMH for routine services costs (RSCs). All costs were converted to 2006 values using the Thai consumer price indices. It was found that the full cost of allogeneic HSCT (allo-HSCT) and autologous HSCT (auto-HSCT) in the first year of the program was $22,592.85 and $24,171.25 per case respectively. Cost-effective appraisal, comparing with chemotherapy, need to be studied further.",null,"Thailand",2007,null,"Stem Cell Therapy",null,"Adults","Direct","Retrospective Analysis","Thailand","Adults",null,"Stem Cell Therapy","Direct","Retrospective Analysis",null,"2005:2009"]
[49,"Pashko, S., et al. (1991). \"The cost-effectiveness of idarubicin/cytosine arabinoside versus daunorubicin/cytosine arabinoside in the treatment of adults with acute myeloid leukemia.\" Clin Ther 13(3): 353-360.",null,"Pashko, S., et al.","The cost-effectiveness of idarubicin/cytosine arabinoside versus daunorubicin/cytosine arabinoside in the treatment of adults with acute myeloid leukemia","The cost-effectiveness of two chemotherapeutic regimens was evaluated from the results of a randomized clinical trial involving patients with previously untreated acute myeloid leukemia. The evaluable subjects were 120 patients with acute myeloid leukemia randomly assigned to receive 12 mg/m2 of idarubicin (IDA) or 50 mg/m2 of daunorubicin (DNR) daily for three days. The patients also received 200 mg/m2 of cytosine arabinoside daily for five days, with an additional 25-mg/m2 bolus on the first day of treatment, the patients underwent a second course at the same doses. The total hospital charges per patient were $59,687 for IDA treatment and $59,567 for DNR treatment; however, the cost per complete remission was lower in the IDA than in the DNR patients ($74,609 vs $102,115). The lower remission rate in the DNR-treated patients, and thus their need for additional care, will increase the cost differences between the two treatments. The hospital charges per year of survival were $36,395 for IDA treatment and $52,714 for DNR treatment. It is concluded that IDA is more cost-effective than DNR in the treatment of adult acute myeloid leukemia.",null,"USA",1991,null,"Conventional Chemo",null,"General","Direct","RCT","USA","General",null,"Conventional Chemo","Direct","RCT",null,"1960:1999"]
[50,"Phillips, M., et al. (1991). \"Acute myeloid leukaemia in childhood: the costs and benefits of intensive treatment.\" Br J Haematol 77(4): 473-477.",null,"Phillips, M., et al.","Acute myeloid leukaemia in childhood: the costs and benefits of intensive treatment","Response to treatment and resource implications were compared in two groups of children with acute myeloid leukaemia (AML) treated during consecutive periods. Event-free survival at 5 years improved from 12% (SE 3.4) during 1972-82 (group A) to 45% (SE 6.9) during 1983-87 (group B). The median time spent in hospital increased from 35 to 170 d. Allogeneic marrow transplantation was offered to all eligible children in group B. Eleven of the 53 children had a suitable donor and 10 proceeded to bone marrow transplantation (BMT). The relapse rate was lower after BMT than after chemotherapy, although not significantly so. We conclude that there has been a real improvement in prognosis for children with AML; that modern treatment requires intensive hospital resources and that these results should encourage further efforts to improve outlook and to explore treatments not involving radiation.",null,"UK",1991,null,"Stem Cell Therapy",null,"Children","Unknown","Cohort Study","UK","Children",null,"Stem Cell Therapy","Unknown","Cohort Study",null,"1960:1999"]
[51,"Redaelli, A., et al. (2004). \"Economic burden of acute myeloid leukemia: a literature review.\" Cancer Treat Rev 30(3): 237-247.",null,"Redaelli, A., et al.","Economic burden of acute myeloid leukemia: a literature review","OBJECTIVE: The primary objective was to examine the economic burden associated with acute myeloid leukemia (AML), a deadly hematological malignancy. AML is the most common form of acute leukemia in adults, particularly in individuals over 60 years of age; AML also accounts for 15-20% of childhood leukemia. MATERIALS AND METHODS: A systematic review was conducted of relevant studies published in the English language. Economic analyses of AML published between 1990 and 2002 were identified from electronic data sources using broad search criteria. Additional studies were obtained by manual searches of bibliographies of articles identified in the electronic searches. Articles were screened for relevance and included if the main theme included some element of AML cost of treatment, cost drivers, or cost-effectiveness. Studies reporting only drug prices without a formal comparison or analysis were not included. RESULTS: Twenty-nine studies were included in the review. Although information was limited on the comprehensive economic burden of AML from a societal perspective, the costs appear to be split equally between direct and indirect costs. Direct costs of AML from a public payer perspective were available for a few countries such as the Netherlands, Sweden, US (Medicare), and Italy. These studies found that the key cost drivers appear to be hospitalization length of stay related to initial chemotherapy, relapse of disease, and bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT). Several cost analyses have been published comparing the different treatment strategies; however, most of them were published in the early 1990s, and their analysis revolved around cost-comparison rather than comprehensive cost-effectiveness. The published studies investigated pharmacological agents (e.g., idarubicin, daunorubicin, mitoxantrone, fludarabine and combination therapies), as well as BMT, PBSCT, and the treatment of complications. CONCLUSION: Studies addressing the economic costs and burden of AML are relatively sparse in the international literature. Possible reasons for such a lack of information appear to include the low incidence rate of AML (e.g., about 260,000 new cases were reported in 2002 in the world) and the fact that it primarily afflicts older adults >60 years of age, making broad, well-designed economic analyses a challenge for most researchers. However, due to the high cost associated with the medical procedures (e.g., BMT, PBSCT) and the aging of the world population, further research is warranted.",null,"Italy",2004,null,"Stem Cell Therapy",null,"General","Direct,Indirect,Resource Use","Systematic Review","Italy","General",null,"Stem Cell Therapy","Direct,Indirect,Resource Use","Systematic Review",null,"2000:2004"]
[52,"Rees, J. K., et al. (1996). \"Dose intensification in acute myeloid leukaemia: greater effectiveness at lower cost. Principal report of the Medical Research Council's AML9 study. MRC Leukaemia in Adults Working Party.\" Br J Haematol 94(1): 89-98.",null,"Rees, J. K., et al.","Dose intensification in acute myeloid leukaemia: greater effectiveness at lower cost. Principal report of the Medical Research Council's AML9 study. MRC Leukaemia in Adults Working Party","Between 1984 and 1990, 972 patients aged 1-79 years with acute myeloid leukaemia (AML), from 85 British hospitals, were entered into the MRC's 9th AML trial. Patients were randomized between DAT 1 + 5 (daunorubicin for 1 d, with cytarabine and 6-thioguanine for 5 d) and DAT 3 + 10 (same dose drugs for 3 and 10 d respectively) as induction therapy. The 63% who achieved complete remission (CR) were randomized to receive two courses of DAT 2 + 7 alternating with two courses of either MAZE (m-AMSA, 5-azacytidine, etoposide) or COAP (cyclophosphamide, vincristine, cytarabine, prednisone). Finally, those still in CR were randomized to receive either 1 year of maintenance treatment with eight courses of cytarabine and thioguanine followed by four courses of COAP, or no further cytotoxic therapy. Resistance to induction therapy was less common with the DAT 3 + 10 regimen than with DAT 1 + 5 (13% v 23%; P = 0.0001) and hence, despite a 5% increase in the risk of induction death, the CR rate was higher (66% v 61%; P = 0.15). Moreover, CR was achieved more rapidly with DAT 3 + 10 (median 34 v 46 d; P < 0.0001) and thus patients required less time in hospital (mean 20 v 29 d) and less blood product support. 5-year relapse-free survival (28% v 23%; P = 0.05) and survival (23% v 18%; P < 0.05) were also better with DAT 3 + 10. Post-remission intensification of therapy with MAZE resulted in fewer relapses (66% v 74% at 5 years; P = 0.03) but patients allocated MAZE required considerably more supportive care and 14 (4.5%) died following 312 MAZE courses, whereas no deaths occurred following COAP. 5-year survival was not significantly higher with MAZE (37% v 31%). Finally, although 1 year of outpatient maintenance treatment appeared to delay, but not prevent, recurrence it did not improve 5-year survival which was non-significantly worse for those allocated maintenance treatment (41% v 44%). We conclude that the more intensive induction regimen, DAT 3 + 10, is not only more effective than DAT 1 + 5, even for older patients, but is also less expensive; intensive post-remission therapy with MAZE achieves better leukaemic control but at the cost of substantial toxicity; whereas low-level maintenance therapy confers no apparent advantage in survival as well as being inconvenient and costly.",null,"UK",1996,null,"Conventional Chemo",null,"General","Resource Use","Retrospective Analysis","UK","General",null,"Conventional Chemo","Resource Use","Retrospective Analysis",null,"1960:1999"]
[53,"Sajben, P., et al. (1993). \"Fluconazol plus ofloxacin in prophylaxis of infections in patients with acute leukemia: a comparative study.\" Support Care Cancer 1(4): 214-216.",null,"Sajben, P., et al.","Fluconazol plus ofloxacin in prophylaxis of infections in patients with acute leukemia: a comparative study","In a retrospective study the incidence of infections, number of afebrile days, duration of antimicrobial chemotherapy, and cost of antibacterials and antimycotics were compared in two groups of patients. One was a group of 57 patients who received no prophylaxis during induction remission therapy of acute leukemia treated in 1989-1990, the second was a group of 22 patients treated in 1991 where prophylaxis with fluconazol and ofloxacin was administered. For ethical reasons pertaining since 1991, when prophylaxis became mandatory, the study was not randomized. A decrease in the number of febrile days, the cost of antimicrobials and the duration of treatment with antibiotics and antimycotics was observed in the group receiving fluconazol and ofloxacin.",null,"Slovakia",1993,null,"Antifungal,Antibiotics",null,"General","Resource Use,Direct","Retrospective Analysis","Slovakia","General",null,"Antifungal,Antibiotics","Resource Use,Direct","Retrospective Analysis",null,"1960:1999"]
[54,"Schimmer, A. D., et al. (2002). \"The autologous blood and marrow transplant long-term follow-up clinic: a model of care for following and treating survivors of autotransplant.\" Support Care Cancer 10(3): 247-252.",null,"Schimmer, A. D., et al.","The autologous blood and marrow transplant long-term follow-up clinic: a model of care for following and treating survivors of autotransplant","The number of long-term survivors of autologous blood and marrow transplantation (ABMT) is increasing, but little is known about the models of care used to follow these patients. Such information would help in comparison of different methods of follow-up and allow other centers to create programs to follow their survivors. Here we describe a multidisciplinary long-term follow-up clinic for survivors of ABMT and report patient satisfaction with the clinic and economic analysis 1.5 years after its inception. In its first 1.5 years of operation, 83 new patients were seen in the clinic. Patients were evaluated a median of 4.0 years after ABMT (range 4.9 months to 12 years) and were a median of 48.5 years (range 22.5-69.0 years) old. Patients received their ABMT for non-Hodgkin's lymphoma ( n=26), Hodgkin's disease ( n=18), acute myeloid leukemia ( n=18), multiple myeloma ( n=15), breast cancer ( n=5), or desmoplastic round-cell tumor ( n=1). Patient satisfaction was assessed 1.5 years after the establishment of the long-term follow-up clinic by means of a self-report questionnaire. Seventy-five percent of patients returned the survey. Waiting times in the clinic were short, with 70% of patients seen within 30 minutes of arrival. Overall, patients were very satisfied with the new clinic model, with 85% patients reporting that the clinic met their expectations. An economic analysis indicated that the estimated annual cost of operating the clinic was approximately $53,000, which translates into $440 per patient visit, $962 per new patient or $172 per patient visit with the clinic operating at peak capacity. In conclusion, we present an inexpensive model of care for ABMT survivors that can be extended to adult survivors of malignancy not treated by ABMT.",null,"Canada",2002,null,"Stem Cell Therapy",null,"General","Resource Use","Cohort Study","Canada","General",null,"Stem Cell Therapy","Resource Use","Cohort Study",null,"2000:2004"]
[55,"Sornsuvit, C., et al. (2008). \"Pilot Study: effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy-induced side-effects in acute myeloid leukaemia patients.\" J Int Med Res 36(6): 1383-1391.",null,"Sornsuvit, C., et al.","Pilot Study: effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy-induced side-effects in acute myeloid leukaemia patients","The effect of parenteral glutamine dipeptide (Gln) supplementation on neutrophil phagocytosis, superoxide anion generation (SAG), prevention of chemotherapy-induced side-effects and cost-effectiveness was examined in a pilot study of acute myeloid leukaemia (AML) patients receiving chemotherapy. Sixteen AML patients were randomized to receive intravenous supplementation with Gln (30 g/day) or an equivalent quantity (25 g/day) of a standard amino acid mixture (control) on days 1 - 5 of chemotherapy. Complete blood count was evaluated twice a week until hospital discharge, and neutrophil phagocytosis and SAG were measured when absolute neutrophil count reached > 500 /microl. Patients were observed for development of infection, mucositis and diarrhoea. In Gln-treated patients, the percentage of neutrophil phagocytosis and the SAG levels were significantly higher than in control patients (20.5 +/- 6.0% and 18.9 +/- 2.9 nmol/10(6) neutrophils per 10 min, respectively). The Gln-treated patients lost significantly less weight, tended to have shorter in-patient duration and had less severe oral mucositis than controls. This pilot study provides preliminary indication that parenteral Gln supplementation enhances neutrophil phagocytic function, maintains nutritional status and is cost effective. Parenteral Gln may also prevent oral mucositis, although further studies involving more patients need to be undertaken to confirm this and the other results.",null,"Thailand",2008,null,"Supportive Care",null,"General","Resource Use","Cohort Study","Thailand","General",null,"Supportive Care","Resource Use","Cohort Study",null,"2005:2009"]
[56,"Stalfelt, A. M. and H. Brodin (1994). \"Costs over time in conventional treatment of acute myeloid leukaemia. A study exploring changes in treatment strategies over two decades.\" J Intern Med 236(4): 401-409.",null,"Stalfelt, A. M. and H. Brodin","Costs over time in conventional treatment of acute myeloid leukaemia. A study exploring changes in treatment strategies over two decades","OBJECTIVES: The aim was to analyse the consumption of different items in conventional treatment of acute myeloid leukaemia (AML) and their cost, in order to evaluate the economic consequences of new treatment strategies. DESIGN: Data on items of treatment were gathered retrospectively from case notes, including amount and date. Prices were gathered from price lists made up for internal billing/accounting. SETTING: The patients were all treated in a hospital with excellent treatment and service facilities. SUBJECTS: Seventy-three AML patients treated from 1973 to 1980, all since deceased, were compared with 54 patients treated from 1981 to 1988, of whom 14 were alive at the end of the observation period. INTERVENTIONS: The patients were treated according to randomized treatment protocols to achieve complete remission. Maintenance treatment or consolidation courses were given. In relapse, new induction treatment was given. MAIN OUTCOME MEASURES: Complete remission and survival were registered. The costs were divided into basic hospital costs and patient-specific costs. RESULTS: The mean total treatment cost for an AML patient in the 1970s was 211,138 SEK, and in 1980s 356,911 SEK. (UK 1 pound = 10.57 SEK, US$1 = 5.91 SEK 1990). All treatment costs increased between the periods: hospital costs by 20%, and patient-specific costs by 186%. Antibiotics, cytostatics and outpatient department costs had increased the most. The mean survival time almost doubled, and in the 1980s group there were several long-term survivors. CONCLUSIONS: The costs for AML treatment increased considerably from the 1970s to the 1980s. The effectiveness of these treatments increased as well, resulting in increased rate and duration of survival, and several patients were long-term survivors. It was not possible to identify the cost consequences of separate new technologies.",null,"Sweden",1994,null,"Unknown",null,"General","Resource Use,Direct,Indirect","Retrospective Review","Sweden","General",null,"Unknown","Resource Use,Direct,Indirect","Retrospective Review",null,"1960:1999"]
[57,"Stalfelt, A. M., et al. (1994). \"Cost analysis of different phases of acute myeloid leukaemia.\" Leuk Res 18(10): 783-790.",null,"Stalfelt, A. M., et al.","Cost analysis of different phases of acute myeloid leukaemia","Priority lists have been formulated in several countries and cut-backs can be a threat to leukaemia treatment. We analysed the costs in different phases of disease for 54 conventionally treated patients with acute myeloid leukaemia. Thirty-two patients reached CR 1, seven patients are still alive as of May 1994. We found a cost per week and patient of 17,334 Swedish Crowns (SEK) (U.K. 1 pound = 10.57 and U.S. $1 = 5.91, 1990) in induction phase, 1854 in remission phase and 10,529 SEK in relapse phase. In the terminal phase 10% of the total cost was spent. The quality of life of the patients in relapse is discussed and palliative treatment is emphasized.",null,"Sweden",1994,null,"Unknown",null,"General","Direct","Retrospective Analysis","Sweden","General",null,"Unknown","Direct","Retrospective Analysis",null,"1960:1999"]
[58,"Stam, W. B., et al. (2008). \"Economic evaluation of posaconazole vs. standard azole prophylaxis in high risk neutropenic patients in the Netherlands.\" Eur J Haematol 81(6): 467-474.",null,"Stam, W. B., et al.","Economic evaluation of posaconazole vs. standard azole prophylaxis in high risk neutropenic patients in the Netherlands","BACKGROUND: Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients experience prolonged neutropenia after treatment with intensive chemotherapy, leading to a high risk of invasive fungal infections (IFI). The present study evaluates the cost effectiveness of posaconazole vs. standard azoles for the prevention of IFIs in neutropenic patients in the Netherlands. METHODS: A decision-tree model was developed using data from a randomized trial that compared posaconazole and standard azole (fluconazole or itraconazole) prophylaxis in neutropenic patients receiving remission-induction chemotherapy for AML/MDS (Cornely et al., N Engl J Med 2007;356:348-359). Following initiation of prophylaxis, clinical events are modeled with chance nodes reflecting probabilities of IFIs, IFI-related death, and death from other causes. Patients surviving the prophylaxis are assumed to have a life expectancy according to the underlying condition. This allows translation of the trial outcomes to a lifetime horizon. Data on life expectancy, quality of life, medical resource consumption and costs were obtained from the literature. Model outcomes include cost per life year (LY) gained and cost per quality adjusted life year (QALY) gained. RESULTS: The total cost (treatment of breakthrough IFI + prophylaxis) for posaconazole amounted to 4412 euros (95% uncertainty interval 3403 euros - 5666 euros), which is -183 euros (-1985 euros to 1564 euros) less than costs with standard azoles. Posaconazole prophylaxis resulted in 0.08 (0.02-0.15) QALYs gained in comparison with prophylaxis with standard azoles. Results from a probabilistic sensitivity analysis indicate that there is a 90% probability that the cost per QALY gained with posaconazole is below 20,000 euros. Additional scenario analyzes with different assumptions confirmed these findings. CONCLUSION: Given the underlying data and assumptions, the economic evaluation demonstrated that posaconazole prophylaxis is expected to be cost-effective compared with fluconazole/itraconazole in neutropenic AML/MDS patients after intensive chemotherapy.",null,"The Netherlands",2008,null,"Antifungal,Conventional Chemo",null,"General","Resource Use,Direct","RCT","The Netherlands","General",null,"Antifungal,Conventional Chemo","Resource Use,Direct","RCT",null,"2005:2009"]
[59,"Standaert, B., et al. (2002). \"Economic analysis of filgrastim use for patients with acute myeloid leukaemia in the UK: a comparison of collection methods of resource use data.\" Pharmacoeconomics 20(10): 665-674.",null,"Standaert, B., et al.","Economic analysis of filgrastim use for patients with acute myeloid leukaemia in the UK: a comparison of collection methods of resource use data","BACKGROUND: A clinical trial of patients with de novo acute myeloid leukaemia (AML) showed that haematopoietic support with filgrastim (granulocyte colony-stimulating factor, G-CSF) following induction and consolidation chemotherapy accelerated recovery from neutropenia. The clinical benefits included reductions in infections, anti-infective therapy and length of hospital stay. OBJECTIVE: The objective of this economic analysis is 2-fold. First, it aims to determine if the observed clinical benefits from the use of filgrastim would lead to cost savings from the perspective of a healthcare institution in the UK. Second, the analysis compares the results of two methods on collection of resource use data. DESIGN: A retrospective cost-minimisation analysis was undertaken based on the clinical results of all UK patients enrolled in the trial. Two cost models were developed: a model based only on the medical resource use collected in the case report forms (the CRF model); and a model based on all medical resources collected from patient medical files (the PF Model). Treatment costs of AML between filgrastim and the placebo arm were compared for the first induction cycle as well as the first induction and the first consolidation cycles combined. Results from the two models were compared. SETTING AND PATIENTS: The CRF model was applied to two samples of patients: all UK patients (n = 82) and patients enrolled at one centre [the Manchester Royal Infirmary (MRI) (n = 30)], whereas the PF model was applied to the MRI patient sample only. RESULTS: For all UK patients, using the CRF model, the filgrastim-treated arm produced cost savings of 747 pounds sterling (9.0%) and 2135 pounds sterling (14.4%) [1998 values] per patient in the first induction cycle and in the induction and consolidation cycles combined, respectively. For the patients at MRI the CRF model resulted in cost savings with filgrastim of 177 pounds sterling (2.2%) and 414 pounds sterling (3.2%) per patient respectively. Using the PF model the savings at MRI were 910 pounds sterling (8.6%) and 1285 pounds sterling (8.0%) per patient, respectively. CONCLUSION: Use of filgrastim in the treatment of AML in the UK may result in net cost savings. A retrospective analysis using total resources obtained through patient files produced higher cost savings estimates than that obtained by resources noted in the CRFs. The models based on PF resource data may be more reliable because they are more comprehensive. However, the cost estimates in this study may have been impacted by sample size, site characteristics, disease and treatment settings. Therefore, further evaluation on the methods for collecting resource use data in larger, multicentred studies is warranted.",null,"USA",2002,null,"CSF",null,"General","Resource Use,Direct","Retrospective Analysis","USA","General",null,"CSF","Resource Use,Direct","Retrospective Analysis",null,"2000:2004"]
[60,"Sung, A. H., et al. (2015). \"An update to the cost-effectiveness of posaconazole vs fluconazole or itraconazole in the prevention of invasive fungal disease among neutropenic patients in the United States.\" J Med Econ 18(5): 341-348.",null,"Sung, A. H., et al.","An update to the cost-effectiveness of posaconazole vs fluconazole or itraconazole in the prevention of invasive fungal disease among neutropenic patients in the United States","OBJECTIVES: Posaconazole has shown superior clinical efficacy in the prevention of invasive fungal disease (IFD) among neutropenic patients as well as cost-effectiveness in the US healthcare setting vs fluconazole or itraconazole (FLU/ITRA) based on oral suspension formulations of each therapy. This study aims to provide an update on the cost-effectiveness of posaconazole in the current US healthcare setting to reflect bioequivalent tablet formulations of posaconazole and fluconazole, as well as changes in healthcare and drug costs. METHODS: An existing model was used to assess the cost-effectiveness of posaconazole vs FLU/ITRA in the prevention of IFD among patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) and chemotherapy-induced neutropenia. Drug efficacy, mortality related to IFD, and death from other causes were estimated for tablet formulations using data from a randomized clinical trial of oral suspensions based on bioequivalence. IFD treatment costs were updated using the average inflation rate over 8 years (2006-2014) and drug costs were based on 2014 Analysource data. RESULTS: Trial data show a lower IFD probability over 100 days of follow-up with posaconazole compared to standard azole therapy (0.05 vs 0.11). The treatment duration on posaconazole is 29 days compared to 24 days for FLU and 29 days for ITRA. The average cost of prophylaxis is higher in the posaconazole group compared to FLU/ITRA ($4673 vs $353); however, the costs associated with treating the IFD are lower in the posaconazole group compared to FLU/ITRA ($2205 vs $5303). The incremental cost effectiveness ratio of IFD avoided for posaconazole is $18,898 vs FLU/ITRA. CONCLUSIONS: In the current healthcare cost environment where both drug costs and overall IFD treatment costs have increased since 2007, posaconazole tablets are a cost-effective alternative to fluconazole or itraconazole in the prevention of IFD among neutropenic patients with AML and MDS in the US.",null,"USA",2015,null,"Antifungal",null,"General","Direct","RCT","USA","General",null,"Antifungal","Direct","RCT",null,"2015:2018"]
[61,"Takeshita, A., et al. (1995). \"Significant reduction of medical costs by differentiation therapy with all-trans retinoic acid during remission induction of newly diagnosed patients with acute promyelocytic leukemia. The Japan Adult Leukemia Study Group.\" Cancer 76(4): 602-608.",null,"Takeshita, A., et al.","Significant reduction of medical costs by differentiation therapy with all-trans retinoic acid during remission induction of newly diagnosed patients with acute promyelocytic leukemia. The Japan Adult Leukemia Study Group","BACKGROUND: Differentiation therapy with all-trans retinoic acid (RA) induces more than 80% complete remission with the least complications in patients with acute promyelocytic leukemia (APL). The authors studied the cost-benefit of this new treatment modality compared with conventional chemotherapy in newly diagnosed patients with APL. METHODS: Costs were calculated retrospectively through the monthly bills of each patient to national health insurance and were compared between 36 patients treated with conventional chemotherapy in the AML-87 or AML-89 studies and 40 patients treated with all-trans RA alone or with all-trans RA plus low dose chemotherapy in the AML-92 study of the Japan Adult Leukemia Study Group who were treated at 22 university and cancer hospitals in Japan. RESULTS: Average medical costs except for antileukemic drugs during 2 months after admission were 4,164,026 yen (approximately US$46,300) in the chemotherapy group and 2,906,825 yen (approximately US$32,300) in the all-trans RA group (P < 0.0001). The difference resulted mainly from the costs of antibiotics and of platelet and erythrocyte transfusions. Average costs of antibiotics were 650,494 yen (approximately US$7,200) and 349,138 yen (approximately US$3,900), respectively (P < 0.0002), and those of platelet and erythrocyte transfusions were 1,016,190 yen (approximately US$11,300) and 633,444 yen (approximately US$7,000), respectively (P < 0.0020). CONCLUSION: During the remission induction therapy of newly diagnosed APL, all-trans RA significantly reduced medical costs. all-trans RA should be incorporated into the front-line therapy of patients with APL for medical and economic reasons.",null,"Japan",1995,null,"Various",null,"Adults","Direct","Retrospective Analysis","Japan","Adults",null,"Various","Direct","Retrospective Analysis",null,"1960:1999"]
[62,"Tallman, M., et al. (2015). \"Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States.\" Clin Lymphoma Myeloma Leuk 15(12): 771-777.",null,"Tallman, M., et al.","Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States","INTRODUCTION: This study estimated the cost-effectiveness of arsenic trioxide (ATO) added to all-trans retinoic acid (ATRA) when used in first-line acute promyelocytic leukemia (APL) treatment. MATERIALS AND METHODS: A Markov cohort model was developed with 3 states: stable disease (during first- or second-line treatment), disease event, and death. Newly diagnosed patients with low- to intermediate-risk APL were included and each month could remain in their current health state or move to another. Treatment consisted of ATO + ATRA, ATRA + idarubicin (IDA), or ATRA + cytarabine (AraC) + additional chemotherapy. After an initial disease event, patients discontinued first-line therapy and switched to a second-line ATO regimen. Efficacy and safety data were obtained from published trials; quality of life/utility estimates were obtained from the literature; costs were obtained from US data sources. Costs and outcomes over time were used to calculate incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Compared to ATRA + AraC + additional chemotherapy, ATRA + IDA treatment had ICERs of $2933 per life-year (LY) saved and $3122 per quality-adjusted life-year (QALY) gained. Compared to the ATRA + IDA regimen, first-line ATO + ATRA treatment had ICERs of $4512 per LY saved and $5614 per QALY gained. Results were sensitive to changes in pharmacy costs of the ATO + ATRA regimen during consolidation. CONCLUSION: The ATO + ATRA regimen is highly cost-effective compared to ATRA + AraC + additional chemotherapy or ATRA + IDA in the treatment of newly diagnosed low- to intermediate-risk APL patients.",null,"UK",2015,null,"Various",null,"General","Direct","Retrospective Analysis","UK","General",null,"Various","Direct","Retrospective Analysis",null,"2015:2018"]
[63,"Tennvall, G. R., et al. (1994). \"The economic costs of acute myeloid leukemia in Sweden.\" Int J Technol Assess Health Care 10(4): 683-694.",null,"Tennvall, G. R., et al.","The economic costs of acute myeloid leukemia in Sweden","The direct and indirect costs of acute myeloid leukemia were estimated for Sweden in 1989. The calculated total cost was SEK 460 million. Nearly half of the costs, or 1.7 million per patient diagnosed, were indirect costs due to premature mortality. Direct costs of relapses and indirect costs of mortality represent costs due to the absence of completely curable therapy. They also represent potential cost savings that could be obtained after introduction of new treatment options in the future.",null,"Sweden",1994,null,"Unknown",null,"Unknown","Direct,Indirect","Unknown","Sweden","Unknown",null,"Unknown","Direct,Indirect","Unknown",null,"1960:1999"]
[64,"Thomas, X., et al. (2007). \"Autologous stem cell transplantation after complete remission and first consolidation in acute myeloid leukemia patients aged 61-70 years: results of the prospective EORTC-GIMEMA AML-13 study.\" Haematologica 92(3): 389-396.",null,"Thomas, X., et al.","Autologous stem cell transplantation after complete remission and first consolidation in acute myeloid leukemia patients aged 61-70 years: results of the prospective EORTC-GIMEMA AML-13 study","BACKGROUND AND OBJECTIVES: The optimal post-remission treatment for elderly patients with acute myeloid leukemia (AML) is presently unknown. Recent studies have reported the feasibility of autologous peripheral blood stem cell transplantation (PBSCT) in this population. We evaluate the outcome of this post-remission approach after complete remission (CR) and consolidation in elderly patients included in the EORTC-GIMEMA AML-13 trial. DESIGN AND METHODS: PBSCT after induction and consolidation chemotherapy was evaluated in patients aged 61 to 70 years with a WHO performance status 0-1. The induction therapy was mitoxantrone, etoposide and cytarabine (MICE) with or without granulocyte colony-stimulating factor (G-CSF) during and/or after chemotherapy. The consolidation therapy consisted of non-infusion or infusional idarubicin, etposide and cytarabine (mini-ICE). RESULTS: Sixty-one patients were scheduled for stem cell harvest by leukapheresis after s.c. recombinant human G-CSF administration initiated after hematopoietic recovery from consolidation. Stem cells were effectively harvested from 54 patients. A median of two aphereses (range, 1-5) were performed, resulting in a median collection of 11.7 x 10(8) nucleated cells/kg (range, 2.4-99.8) containing 40.2 x 10(4) CFU-GM/kg (range, 0-786.8), and 5 x 10(6) CD34+ cells/kg (range, 0.1-99.8). For the whole group of 61 patients, the median disease-free survival (DFS) was 1.0 years and the 3-year DFS rate was 21%, while the median overall survival (OS) was 1.4 years and the 3-year OS rate was 32%. A total of 26 patients could not be autografed due to inadequate/no harvest (21 patients), early relapse (3 patients), or treatment refusal (2 patients). Autologous transplantation was performed in 35 patients following conditioning with the BAVC regimen. The median time for granulocyte recovery >0.5 109 yen/L was 24 days and for platelets >20 x10(9)/L was 23 days following transplantation. After a median follow-up of 5.0 years from transplantation, the median DFS and OS were 1.1 and 1.6 years respectively, and the 3-year rates were 28% and 39% respectively. Eight autografted patients were still in continuous complete remission, 22 patients had relapsed and five had died in CR. INTERPRETATION AND CONCLUSIONS: Intensification of remission including autologous PBSCT is feasible in about half of harvested patients aged 61 to 70 years old, and did not improve the general outcome. This shows the limitations of autologous PBSCT and other intensive treatment modalities in elderly AML patients. Key words: acute myeloid leukemia, elderly, autologous stem cell transplantation.",null,"France",2007,null,"Stem Cell Therapy",null,"Elderly","Resource Use","Clinical trial","France","Elderly",null,"Stem Cell Therapy","Resource Use","Clinical trial",null,"2005:2009"]
[65,"Uyl-de Groot, C. A., et al. (2001). \"Costs of diagnosis, treatment, and follow up of patients with acute myeloid leukemia in the netherlands.\" J Hematother Stem Cell Res 10(1): 187-192.",null,"Uyl-de Groot, C. A., et al.","Costs of diagnosis, treatment, and follow up of patients with acute myeloid leukemia in the netherlands","The aim of the study was to calculate the costs in various places of acute myeloid leukemia (AML). Patients less than 65 years old, who were treated for newly diagnosed AML were included. The cost analysis distinguished between diagnosis, treatment, follow-up (maximum of 2 years), and treatment of relapse. The treatment period was divided into remission induction and consolidation treatment, harvest of bone marrow (BM) or peripheral blood stem cells, and transplantation. The costs of diagnosis amounted to $3,167 (1995 US$). Remission-induction treatments cost on average $46,387 and harvest of bone marrow or peripheral blood stem cells costs $6,491. The costs of the transplantation varied between $25,531 and $44,087. Costs of follow-up amounted to $4,167. Relapse treatment, mainly consisting of reinduction therapy, costs on average $24,338. The total average weighted costs of AML patients amounted to $104,386. Treating AML patients is very expensive, and major reductions in costs are not expected in the next future. Considering efficacy and effectiveness, it seemed that choices based on costs could be made between several consolidation techniques and between a specific consolidation technique and/or palliative treatment.",null,"The Netherlands",2001,null,"Unknown",null,"General","Direct","Retrospective Analysis","The Netherlands","General",null,"Unknown","Direct","Retrospective Analysis",null,"2000:2004"]
[66,"Uyl-de Groot, C. A., et al. (1996). \"Colony-stimulating factors and peripheral blood progenitor cell transplantation. Benefits and costs.\" Pharmacoeconomics 10(1): 23-35.",null,"Uyl-de Groot, C. A., et al.","Colony-stimulating factors and peripheral blood progenitor cell transplantation. Benefits and costs","High dosage chemo- or radiotherapy followed by the administration of autologous bone marrow-derived stem cells [i.e. autologous bone marrow transplantation (ABMT)] is an established protocol for treating acute myeloid leukaemia and malignant lymphoma. The approach is also under investigation in the treatment of acute lymphocytic leukaemia, multiple myeloma and solid tumours. In all of these diseases, the optimisation of indications, conditioning schemes, stem cell harvest techniques and supportive care with growth factors is subject to continuous preclinical research and clinical phase II and III studies. Recently, the administration of peripheral blood stem cell preparations to cancer patients as rescue therapy after high dosage antitumour therapy has been received with much enthusiasm. At first glance, the technique looks rather easy to perform. The faster recovery of haemopoiesis, compared with ABMT, leads to shorter durations of hospitalisation. Moreover, in most studies, peripheral blood progenitor cell transplantation (PBPCT) resulted in fewer septic episodes, fewer intensive care admissions, fewer red blood cell and platelet transfusions, reduced use of anti-infectives and parenteral nutrition, and reduced hospital costs compared with ABMT. The overall conclusion is that the treatment costs of PBPCT are 15 to 30% lower than the treatment costs of ABMT. However, a formal comparison between PBPCT and ABMT, assessing the differences in toxicity, costs and quality of life, is still awaited.",null,"The Netherlands",1996,null,"Stem Cell Therapy",null,"Unknown","Direct","Narrative Review","The Netherlands","Unknown",null,"Stem Cell Therapy","Direct","Narrative Review",null,"1960:1999"]
[67,"Uyl-de Groot, C. A., et al. (1998). \"Cost-effectiveness and quality-of-life assessment of GM-CSF as an adjunct to intensive remission induction chemotherapy in elderly patients with acute myeloid leukemia.\" Br J Haematol 100(4): 629-636.",null,"Uyl-de Groot, C. A., et al.","Cost-effectiveness and quality-of-life assessment of GM-CSF as an adjunct to intensive remission induction chemotherapy in elderly patients with acute myeloid leukemia","We conducted a prospective, randomized, multicentre clinical trial comparing the effects and costs of GM-CSF as an adjunct to intensive chemotherapy in elderly patients with acute myeloid leukaemia (AML). The patients were randomized to either daunomycin-cytosine arabinoside (control arm: n = 161) or daunomycin-cytosine arabinoside with GM-CSF (GM-CSF arm: n = 157). The primary end-point was the effect of GM-CSF on the percentage of complete remissions (CR). Survival duration, disease-free survival, quality of life and costs were evaluated separately. CR after remission induction treatment was achieved in 55% of the patients in the control group and in 56% of the patients in the GM-CSF group (P = NS). The duration of survival and disease-free survival at 2 years after randomization were estimated at 22% and 19% for the control group and 22% and 14% for the GM-CSF group (P = NS). Considering the short-term quality of life, the administration of GM-CSF resulted in more problems with regard to depressed mood, diarrhoea and rash/eczema. With regard to the long-term quality of life there were no significant differences between the two groups. The average costs of the primary treatment were higher in GM-CSF-treated patients than in the control group, i.e. US$40782 and US$34465, respectively (P < 0.01). The costs during the follow-up period did not differ between the two groups. The results of this randomized clinical trial indicate that daunomycin-cytosine arabinoside plus GM-CSF is not a cost-effective treatment strategy when compared with daunomycin-cytosine arabinoside alone.",null,"The Netherlands",1998,null,"CSF,Conventional Chemo",null,"Elderly","Direct","RCT","The Netherlands","Elderly",null,"CSF,Conventional Chemo","Direct","RCT",null,"1960:1999"]
[68,"Uyl-de Groot, C. A., et al. (1995). \"Costs of introducing autologous BMT in the treatment of lymphoma and acute leukaemia in The Netherlands.\" Bone Marrow Transplant 15(4): 605-610.",null,"Uyl-de Groot, C. A., et al.","Costs of introducing autologous BMT in the treatment of lymphoma and acute leukaemia in The Netherlands","In a retrospective study we calculated the costs of introducing autologous BMT in the treatment of patients with malignant lymphoma and acute leukaemia in The Netherlands. The cost analysis has been performed in five university hospitals and one cancer centre, in a series of patients with intermediate and high grade non-Hodgkin's lymphoma (NHL) and patients with AML. Conventional treatment consisted of chemotherapy. The average costs of the conventional NHL treatment varied from US$3120 to U$12,900. The costs of autologous BMT amounted to US$40,220. In the AML group the costs of conventional treatment amounted to about US$11,040, as only 50% of the patients were treated further. The costs of autologous BMT including a follow-up period of 2 years, amounted to US$55,440. In The Netherlands the total number of autologous BMTs per year in these patient groups was estimated at 230; 180 in the NHL group and 50 in the AML group. The costs of introducing autologous BMT to the NHL group will vary between 4.93 and 6.68 million dollars and for the AML group these costs were estimated at 2.22 million dollars. As a result, the total extra costs of introducing autologous BMTs are expected to be between 7.15 and 8.9 million dollars.",null,"The Netherlands",1995,null,"Stem Cell Therapy,Conventional Chemo",null,"Unknown","Direct","Retrospective Analysis","The Netherlands","Unknown",null,"Stem Cell Therapy,Conventional Chemo","Direct","Retrospective Analysis",null,"1960:1999"]
[69,"van Agthoven, M., et al. (2002). \"Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia.\" Bone Marrow Transplant 30(4): 243-251.",null,"van Agthoven, M., et al.","Cost analysis of HLA-identical sibling and voluntary unrelated allogeneic bone marrow and peripheral blood stem cell transplantation in adults with acute myelocytic leukaemia or acute lymphoblastic leukaemia","Allogeneic stem cell transplantation (SCT) is one of the most expensive medical procedures. However, only a few studies to date have addressed the costs of HLA-identical sibling transplantation and only one study has reported costs of unrelated transplantation. No recent cost analysis with a proper follow-up period and donor identification expenses is available on related or voluntary matched unrelated donor (MUD) SCT for adult AML or ALL. Therefore, we calculated direct medical (hospital) costs based on 97 adults who underwent HLA-identical sibling bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT), and patients who received a graft from a MUD between 1994 and 1999. The average costs per transplanted patient were Euro 98,334 (BMT), Euro 151,754 (MUD), and Euro 98,977 (PBSCT), including donor identification expenses, 2 years follow-up and costs of patients who were not transplanted after they had been planned to receive an allograft. The majority of these costs was generated during the hospitalisation for graft infusion. For MUD transplants, nearly one-third of these costs was spent on the search for a suitable donor. For patients who were alive after 2 years, cumulative expenses were calculated to be Euro 103,509 (BMT), Euro 173,587 (MUD), and Euro 105,906 (PBSCT).",null,"The Netherlands",2002,null,"Stem Cell Therapy",null,"General","Direct","Cohort Study","The Netherlands","General",null,"Stem Cell Therapy","Direct","Cohort Study",null,"2000:2004"]
[70,"Van de Velde, A. L., et al. (2016). \"Medical costs of treatment and survival of patients with acute myeloid leukemia in Belgium.\" Leuk Res 46: 26-29.",null,"Van de Velde, A. L., et al.","Medical costs of treatment and survival of patients with acute myeloid leukemia in Belgium","The advent of new cell-based immunotherapies for leukemia offers treatment possibilities for certain leukemia subgroups. The wider acceptability of these new technologies in clinical practice will depend on its impact on survival and costs. Due to the small patient groups who have received it, these aspects have remained understudied. This non-randomized single-center study evaluated medical costs and survival for acute myeloid leukemia between 2005 and 2010 in 50 patients: patients treated with induction and consolidation chemotherapy (ICT) alone; patients treated with ICT plus allogeneic hematopoietic stem cell transplantation (HCT), which is the current preferred post-remission therapy in patients with intermediate- and poor-risk AML with few co-morbidities, and patients treated with ICT plus immunotherapy using autologous dendritic cells (DC) engineered to express the Wilms' tumor protein (WT1). Total costs including post- consolidation costs on medical care at the hematology ward and outpatient clinic, pharmaceutical prescriptions, intensive care ward, laboratory tests and medical imaging were analyzed. Survival was markedly better in HCT and DC. HCT and DC were more costly than ICT. The median total costs for HCT and DC were similar. These results need to be confirmed to enable more thorough cost-effectiveness analyses, based on observations from multicenter, randomized clinical trials and preferably using quality-adjusted life-years as an outcome measure.",null,"Belgium",2016,null,"Stem Cell Therapy,Conventional Chemo",null,"General","Direct,Resource use","Cohort Study","Belgium","General",null,"Stem Cell Therapy,Conventional Chemo","Direct,Resource Use","Cohort Study",null,"2015:2018"]
[71,"Vaughn, J. E., et al. (2015). \"Resource Utilization and Safety of Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia or Myelodysplastic Syndrome: A Nonrandomized Clinical Comparative Analysis.\" JAMA Oncol 1(8): 1120-1127.",null,"Vaughn, J. E., et al.","Resource Utilization and Safety of Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia or Myelodysplastic Syndrome: A Nonrandomized Clinical Comparative Analysis","IMPORTANCE: Adults with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) typically remain hospitalized after induction or salvage chemotherapy until blood cell count recovery, with resulting prolonged inpatient stays being a primary driver of health care costs. Pilot studies suggest that outpatient management following chemotherapy might be safe and could reduce costs for these patients. OBJECTIVE: To compare safety, resource utilization, infections, and costs between adults discharged early following AML or MDS induction or salvage chemotherapy and inpatient controls. DESIGN: Nonrandomized, phase 2, single-center study conducted at the University of Washington Medical Center. Over a 43-month period (January 1, 2011, through July 31, 2014), 178 adults receiving intensive AML or MDS chemotherapy were enrolled. After completion of chemotherapy, 107 patients met predesignated medical and logistical criteria for early discharge, while 29 met medical criteria only and served as inpatient controls. INTERVENTIONS: Early-discharge patients were released from the hospital at the completion of chemotherapy, and supportive care was provided in the outpatient setting until blood cell count recovery (median, 21 days; range, 2-45 days). Controls received inpatient supportive care (median, 16 days; range, 3-42 days). MAIN OUTCOMES AND MEASURES: We analyzed differences in early mortality, resource utilization including intensive care unit (ICU) days, transfusions per study day, and use of intravenous (IV) antibiotics per study day), numbers of infections, and total and inpatient charges per study day among early-discharge patients vs controls. RESULTS: Four of the 107 early-discharge patients and none of the 29 control patients died within 30 days of enrollment (P=.58). Nine early-discharge patients (8%) but no controls required ICU-level care (P=.20). No differences were noted in the median daily number of transfused red blood cell units (0.27 vs 0.29; P=.55) or number of transfused platelet units (0.26 vs 0.29; P=.31). Early-discharge patients had more positive blood cultures (37 [35%] vs 4 [14%]; P=.04) but required fewer IV antibiotic days per study day (0.48 vs 0.71; P=.01). Overall, daily charges among early-discharge patients were significantly lower than for inpatients (median, $3840 vs $5852; P<.001) despite increased charges per inpatient day when readmitted (median, $7405 vs $5852; P<.001). CONCLUSIONS AND RELEVANCE: Early discharge following intensive AML or MDS chemotherapy can reduce costs and use of IV antibiotics, but attention should be paid to complications that may occur in the outpatient setting.",null,"USA",2015,null,"Unknown",null,"Adults","Resource Use","Cohort Study","USA","Adults",null,"Unknown","Resource Use","Cohort Study",null,"2015:2018"]
[72,"Walter, R. B., et al. (2011). \"Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study.\" Haematologica 96(6): 914-917.",null,"Walter, R. B., et al.","Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study","Due to infectious and bleeding risks, adults with acute myeloid leukemia or high-risk myelodysplastic syndromes typically remain hospitalized after remission induction chemotherapy until blood count recovery. Here, we explored the medical and financial effects of discharge immediately after chemotherapy completion with close outpatient follow up. Within 12 months, 15 patients fulfilling both medical and logistical criteria were discharged early, whereas 5 patients meeting medical criteria only served as inpatient controls. No patient died. Patients discharged early spent a median of 8 days (range 3-36 days), or 54% of their study time, as outpatients. These patients required less time on intravenous antibiotics (6 vs. 16 days; P=0.11), received fewer red blood cell transfusions (0.25 vs. 0.48 units/day; P=0.08), and incurred lower median daily charges ($3,270 vs. $5,467; P=0.01) than controls. Thus, early discharge of selected patients appears, safe and may reduce cost and resource utilization. (ClinicalTrials.gov Identifier: NCT00844441).",null,"USA",2011,null,"Unknown",null,"General","Resource Use","Clinical trial","USA","General",null,"Unknown","Resource Use","Clinical trial",null,"2010:2014"]
[73,"Wang, H. I., et al. (2014). \"Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model.\" Value Health 17(2): 205-214.",null,"Wang, H. I., et al.","Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model","BACKGROUND: Acute myeloid leukemia (AML) can be diagnosed at any age and treatment, which can be given with supportive and/or curative intent, is considered expensive compared with that for other cancers. Despite this, no long-term predictive models have been developed for AML, mainly because of the complexities associated with this disease. OBJECTIVE: The objective of the current study was to develop a model (based on a UK cohort) to predict cost and life expectancy at a population level. METHODS: The model developed in this study combined a decision tree with several Markov models to reflect the complexity of the prognostic factors and treatments of AML. The model was simulated with a cycle length of 1 month for a time period of 5 years and further simulated until age 100 years or death. Results were compared for two age groups and five different initial treatment intents and responses. Transition probabilities, life expectancies, and costs were derived from a UK population-based specialist registry-the Haematological Malignancy Research Network (www.hmrn.org). RESULTS: Overall, expected 5-year medical costs and life expectancy ranged from pound8,170 to pound81,636 and 3.03 to 34.74 months, respectively. The economic and health outcomes varied with initial treatment intent, age at diagnosis, trial participation, and study time horizon. The model was validated by using face, internal, and external validation methods. The results show that the model captured more than 90% of the empirical costs, and it demonstrated good fit with the empirical overall survival. CONCLUSIONS: Costs and life expectancy of AML varied with patient characteristics and initial treatment intent. The robust AML model developed in this study could be used to evaluate new diagnostic tools/treatments, as well as enable policy makers to make informed decisions.",null,"Norway,UK",2014,null,"Unknown",null,"General","Direct","Cohort Study","Norway,UK","General",null,"Unknown","Direct","Cohort Study",null,"2010:2014"]
[74,"Weiman, M. G. (1995). \"Case management. A means to improve quality and control the costs of cure in children with acute myelogenous leukemia.\" J Pediatr Hematol Oncol 17(3): 248-253.",null,"Weiman, M. G.","Case management. A means to improve quality and control the costs of cure in children with acute myelogenous leukemia","Acute myelogenous leukemia (AML) is a costly disease to treat, as patients experience many hospital stays secondary to chemotherapy, the side effects of treatment, and bone marrow transplantation. The trend for some medical centers has been to reduce costs and increase quality through case management. The case manager uses critical pathways and one-on-one interaction to facilitate the patients' progress through the hospital system and to decrease delays and duplication. CONCLUSION: Case management and critical pathways could become an indispensable tool for the management of pediatric patients with cancer.",null,"USA",1995,null,"Conventional Chemo",null,"Unknown","Unknown","Unknown","USA","Unknown",null,"Conventional Chemo","Unknown","Unknown",null,"1960:1999"]
[75,"Wheatley, K., et al. (2009). \"Randomized placebo-controlled trial of granulocyte colony stimulating factor (G-CSF) as supportive care after induction chemotherapy in adult patients with acute myeloid leukaemia: a study of the United Kingdom Medical Research Council Adult Leukaemia Working Party.\" Br J Haematol 146(1): 54-63.",null,"Wheatley, K., et al.","Randomized placebo-controlled trial of granulocyte colony stimulating factor (G-CSF) as supportive care after induction chemotherapy in adult patients with acute myeloid leukaemia: a study of the United Kingdom Medical Research Council Adult Leukaemia Working Party","The role of granulocyte colony stimulating factor (G-CSF) as supportive therapy following intensive induction chemotherapy for acute myeloid leukaemia (AML) in adults was investigated in a randomized trial. G-CSF (Lenograstim, 263 microg/d) or placebo was administered from day 8 after the end of chemotherapy until neutrophil recovery to 0.5 x 10(9)/l (or for up to 10 d). Eight hundred and three patients were entered. Neutrophil recovery was quicker with G-CSF (P < 0.0001), but this did not lead to differences in the number, severity or duration of infections. There were no substantial supportive care savings, although G-CSF patients spent 2 d less in hospital (P = 0.01). Complete remission (CR) rates were similar between arms (73% G-CSF, 75% placebo, P = 0.5), as were reasons for failure (induction death: P = 0.7; resistant disease: P = 0.5) and, for remitters, 5-year disease-free survival (34% vs. 38%, P = 0.3). Overall survival at 5 years was 29% with G-CSF vs. 36% with placebo (P = 0.10). Both CR rate (P = 0.006) and overall survival (P = 0.006) were worse with G-CSF in patients aged <40 years, but this may be a chance effect. There is some evidence from this trial of an adverse effect of G-CSF but these data need to be viewed in the context of the evidence from the other trials.",null,"UK",2009,null,"CSF",null,"Adults","Resource Use","RCT","UK","Adults",null,"CSF","Resource Use","RCT",null,"2005:2009"]
[76,"Whittington, R. and K. L. Goa (1993). \"Idarubicin: a pharmacoeconomic evaluation of its use in adult patients with acute myeloid leukaemia.\" Pharmacoeconomics 4(4): 287-307.",null,"Whittington, R. and K. L. Goa","Idarubicin: a pharmacoeconomic evaluation of its use in adult patients with acute myeloid leukaemia","Idarubicin is an effective agent in the treatment of acute myeloid leukaemia (AML), inducing complete remission in 39 to 80% of newly diagnosed patients. Although it also demonstrates efficacy as monotherapy, and is of use in relapsed or refractory disease, most comparative clinical trials have administered idarubicin intravenously in combination with cytarabine in newly diagnosed patients. These trials indicate that improved survival and response rates, and rapid achievement of remission, are more likely with idarubicin than with daunorubicin, when both agents are given in combination with cytarabine. In elderly patients, however, response rates are lower than in younger patients, and there is less disparity in efficacy between idarubicin and daunorubicin induction therapy. Although AML is an expensive disease to treat, the majority of costs are associated with the length of hospitalisation, with the acquisition cost of the chemotherapy agents contributing less than 10% to overall expenditure. Idarubicin combined with cytarabine therapy achieved higher response rates with the first cycle of therapy than daunorubicin, thereby reducing the requirements for a second cycle of therapy and further hospitalisation. Compared with daunorubicin plus cytarabine induction treatment, idarubicin plus cytarabine reduced the costs of achieving a complete response by between 22 and 39% in patients with a median age less than 60 years. In patients with a median age of 62 years, who are more representative of the AML population, costs of achieving a complete response were reduced by 3 to 6%. Thus, idarubicin is more cost effective than daunorubicin as induction therapy in combination with cytarabine, in adult patients with AML. The pharmacoeconomic position of idarubicin in postinduction therapy remains to be established.",null,"New Zealand",1993,null,"Conventional Chemo",null,"Unknown","Unknown","Narrative Review","New Zealand","Unknown",null,"Conventional Chemo","Unknown","Narrative Review",null,"1960:1999"]
[77,"Yu, Y. B., et al. (2007). \"Cost-effectiveness of postremission intensive therapy in patients with acute leukemia.\" Ann Oncol 18(3): 529-534.",null,"Yu, Y. B., et al.","Cost-effectiveness of postremission intensive therapy in patients with acute leukemia","BACKGROUND: We assessed the cost-effectiveness of high-dose arabinoside (HiDAC)-based and allogeneic stem-cell transplantation (alloSCT)-based therapy in patients with acute leukemia. PATIENTS AND METHODS: We analyzed the outcome, cost and cost-effectiveness of 106 patients treated from January 1994 to January 2002 [94 acute myelogenous leukemia (AML)/12 acute lymphoblastic leukemia (ALL)]. Forty-two young patients at either intermediate or unknown cytogenetic risk received postremission intensive therapy (24 HiDAC-based/18 alloSCT-based therapy). RESULTS: After a median follow-up of 50 months, the estimated 7-year overall survival for the HiDAC-based group showed a tendency to be higher than the alloSCT-based group (48% versus 28%, P = 0.1452). The HiDAC-based group spent a significantly lower total cost ($US51,857 versus 75,474, P = 0.004) than the alloSCT-based group. Cost-effectiveness analysis showed that the mean cost per year of life saved for the HiDAC-based group is considerably less expensive than the alloSCT-based group ($US11,224 versus 21,564). The reduced total cost for the HiDAC-based group originated from lower cost in room fees, medication, laboratory and procedure, but not in blood transfusion and professional manpower fees. CONCLUSION: For the postremission therapy in young AML patients at either intermediate or unknown cytogenetic risk, cost-effectiveness of HiDAC-based therapy compares favorably with that of alloSCT-based therapy, which deserves further clinical trials.",null,"China",2007,null,"Stem Cell Therapy,Conventional Chemo",null,"General","Direct","Cohort Study","China","General",null,"Stem Cell Therapy,Conventional Chemo","Direct","Cohort Study",null,"2005:2009"]
[78,"Zhao, Y. J., et al. (2015). \"Network Meta-analysis and Pharmacoeconomic Evaluation of Fluconazole, Itraconazole, Posaconazole, and Voriconazole in Invasive Fungal Infection Prophylaxis.\" Antimicrob Agents Chemother 60(1): 376-386.",null,"Zhao, Y. J., et al.","Network Meta-analysis and Pharmacoeconomic Evaluation of Fluconazole, Itraconazole, Posaconazole, and Voriconazole in Invasive Fungal Infection Prophylaxis","Invasive fungal infections (IFIs) are associated with high mortality rates and large economic burdens. Triazole prophylaxis is used for at-risk patients with hematological malignancies or stem cell transplants. We evaluated both the efficacy and the cost-effectiveness of triazole prophylaxis. A network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating fluconazole, itraconazole capsule and solution, posaconazole, and voriconazole was conducted. The outcomes of interest included the incidences of IFIs and deaths. This was coupled with a cost-effectiveness analysis from patient perspective over a lifetime horizon. Probabilities of transitions between health states were derived from the NMA. Resource use and costs were obtained from the Singapore health care institution. Data on 5,505 participants in 21 RCTs were included. Other than itraconazole capsule, all triazole antifungals were effective in reducing IFIs. Posaconazole was better than fluconazole (odds ratio [OR], 0.35 [95% confidence interval [CI], 0.16 to 0.73]) and itraconazole capsule (OR, 0.25 [95% CI, 0.06 to 0.97]), but not voriconazole (OR, 1.31 [95% CI, 0.43 to 4.01]), in preventing IFIs. Posaconazole significantly reduced all-cause deaths, compared to placebo, fluconazole, and itraconazole solution (OR, 0.49 to 0.54 [95% CI, 0.28 to 0.88]). The incremental cost-effectiveness ratio for itraconazole solution was lower than that for posaconazole (Singapore dollars [SGD] 12,546 versus SGD 26,817 per IFI avoided and SGD 5,844 versus SGD 12,423 per LY saved) for transplant patients. For leukemia patients, itraconazole solution was the dominant strategy. Voriconazole was dominated by posaconazole. All triazole antifungals except itraconazole capsule were effective in preventing IFIs. Posaconazole was more efficacious in reducing IFIs and all-cause deaths than were fluconazole and itraconazole. Both itraconazole solution and posaconazole were cost-effective in the Singapore health care setting.",null,"Singapore",2015,null,"Antifungal",null,"General","Direct","Meta Analysis","Singapore","General",null,"Antifungal","Direct","Meta Analysis",null,"2015:2018"]

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[null,"Toggle age cut-offs",null,null,null,null,null,null,7,1,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This year =",{"$f":"YEAR(NOW())","v":2018},null,"Years","Cut","Selected cut state","Start","End",{"$f":"COUNTA(CF3:CF58)","v":5},{"$f":"OFFSET($CI$2,0,domainChoice)","v":"Study methodologies"},"Locations","Interventions","Diseases","PRO tools","subPopulations","Study types","Study methodologies",null,null,null,null,"selected categories"]
[null,null,56,null,null,null,null,null,"Unallocated","Case Study",null,null,null,null,null,null,null,null,null,null,null,"New names","Existing names",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Low year =",{"$f":"MIN($CF$3:$CF$60)","v":1960},null,1960,false,true,1960,1999,{"$f":"IF(CF3<>\"\",_xlfn.CONCAT(CF3,\":\",CG3),\"\")","v":"1960:1999"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Locations"},"Australia","Antibiotics",null,null,"Adults","Direct","Case Study",null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Unallocated"}]
[null,"From",null,null,"To",null,null,null,null,"Case Study",null,null,null,null,null,null,null,null,null,null,null,"C1","C1","Locations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OFFSET($BY$5,domainChoice,0)","v":"studymethodCategories"},"High year =",{"$f":"MAX(CG3:$CG$60)","v":2018},null,1961,false,null,2000,2004,{"$f":"IF(CF4<>\"\",_xlfn.CONCAT(CF4,\":\",CG4),\"\")","v":"2000:2004"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Interventions"},"Belgium","Antifungal",null,null,"Children","Indirect","Clinical trial",null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Case Study"}]
[null,{"$f":"IF(CF3=\"\",\"\",CF3)","v":1960},null,null,{"$f":"IF(CG3=\"\",\"\",CG3)","v":1999},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C2","C2","Interventions",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962,false,"Segment count",2005,2009,"2005:2009","Diseases","Brazil","Azacitidine",null,null,"Elderly","Resource Use","Cohort Study",null,null,null,null,"Clinical trial"]
[null,{"$f":"IF(CF4=\"\",\"\",CF4)","v":2000},null,null,{"$f":"IF(CG4=\"\",\"\",CG4)","v":2004},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C3","C3","Diseases",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"locationCategories",null,null,null,1963,false,null,2010,2014,"2010:2014","PRO tools","Canada","CSF",null,null,"General","Unknown","Decision Analytic Model",null,null,null,null,"Cohort Study"]
[null,2005,null,null,2009,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C4","C4","Sub-populations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"interventionCategories",null,null,null,1964,false,null,2015,2018,"2015:2018","subPopulations","China","Conventional Chemo",null,null,"Unknown",null,"Meta Analysis",null,null,null,null,"Decision Analytic Model"]
[null,2010,null,null,2014,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C5","C5","PRO tools",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"diseaseCategories",null,null,null,1965,false,null,null,null,"","Study types","France","Diagnostics",null,null,null,null,"Narrative Review",null,null,null,null,"Meta Analysis"]
[null,2015,null,null,2018,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study types",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"protoolCategories",null,null,null,1966,false,null,null,null,"","Study methodologies","Germany","Enocitabine",null,null,null,null,"RCT",null,null,null,null,"Narrative Review"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodologies",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"subpopulationCategories",null,null,null,1967,false,null,null,null,"",null,"Italy","Mitoxantrone",null,null,null,null,"Retrospective Analysis",null,null,null,null,"RCT"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Location categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studytypeCategories",null,null,null,1968,false,null,null,null,"",null,"Japan","Stem Cell Therapy",null,null,null,null,"Retrospective Review",null,null,null,null,"Retrospective Analysis"]
[null,{"$f":"IF(CF10=\"\",\"\",CF10)","v":""},null,null,{"$f":"IF(CG10=\"\",\"\",CG10)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Intervention categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studymethodCategories",null,null,null,1969,false,null,null,null,"",null,"New Zealand","Supportive Care",null,null,null,null,"Systematic Review",null,null,null,null,"Retrospective Review"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Disease categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970,false,null,null,null,"",null,"Nicaragua","Unknown",null,null,null,null,"Unknown",null,null,null,null,"Systematic Review"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sub-populations categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1971,false,null,null,null,"",null,"Norway","Various",null,null,null,null,null,null,null,null,null,"Unknown"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRO tool categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,false,null,null,null,"",null,"Republic of Korea",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,{"$f":"IF(CG14=\"\",\"\",CG14)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study type categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1973,false,null,null,null,"",null,"Singapore",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodology categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1974,false,null,null,null,"",{"$f":"COLUMN()","v":87},"Slovakia",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1975,false,null,null,null,"",null,"Sweden",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1976,false,null,null,null,"",null,"Thailand",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1977,false,null,null,null,"",null,"The Netherlands",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1978,false,null,null,null,"",null,"UK",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1979,false,null,null,null,"",null,"USA",null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1980,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",22,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1981,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1982,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1983,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1984,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1985,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1986,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1987,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1988,false,null,null,null,{"$f":"IF(CF31<>\"\",_xlfn.CONCAT(CF31,\":\",CG31),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1989,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1990,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1991,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1992,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1993,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1994,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
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