1092P - Cost of treatment of acute myeloid leukemia - experiences from a developing country

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Leukaemia
Bioethics, Legal, and Economic Issues
Presenter Devavrat Arya
Authors D. Arya1, B. Parikh2, P.M. Shah2, K.M. Patel2, S.N. Shukla2, A.S. Anand2, S.S. Talati2, S.A. Shah2, A.A. Patel2, B.B. Parekh2
  • 1Medical Oncology, Action Cancer Hospital, 110085 - Delhi/IN
  • 2Dept. Of Medical And Pediatric Hemato Oncology, Gujarat Cancer and Research InstituteCivil Hospital Campus, M.P. Shah Cancer Hospital, IN-380016 - Ahmedabad/IN

Abstract

Background

Acute Myeloid leukemia (AML) is a difficult disease to treat requiring specialised induction facilities, doctors, supportive staff and laboratory services. We try to analyse how the cost of diagnosis and treatment combined with socio-cultural and logistical issues affect treatment delivery and outcomes in AML in developing countries like India.

Materials and methods

We conducted a retrospective analysis of case records of adult patients diagnosed with AML between 2009 and 2010 at the Gujarat Cancer and Research Institute, Ahmedabad, India. Patients diagnosed with AML-M3 were excluded. Data reviewed included epidemiological and demographic details, AML subtype, cytogenetic anomalies, co morbidities, treatment offered, complications, and duration of hospital stay. Billing information and other relevant data were retrieved from the hospital electronic records and analysed.

Results

A total of 76 case records of patients with AML were identified (excluding AML- M3). Females comprised 51% of all patients. Majority of diagnosed patients (65%) worked as daily wage labourers. AML-M1 was the predominant subtype (35%). Three % patients expired during initial workup and 27% were offered supportive care only in view of significant co morbidities, advanced age or poor performance status. Thirty four % patients refused treatment because of financial, social or logistical constraints. Only 37 % of all patients received standard 7 + 3 (cytosine arabinoside with daunorubicin) induction treatment. Complication rate during induction therapy was 71% with induction mortality rate being 8%. Average stay in hospital was 34 days and cost of remission induction was equivalent of 1000 dollars with nearly 85% of that amount spent for supportive care. Remission rate was 71%, however only 29% patients were disease free at one year. Survival rate at one year was 61%.

Conclusions

Nearly one third of patients were not candidates for standard treatment in view of significant co morbidities, advanced age or poor performance status. Only 50% of patients candidate for standard treatment received it with the rest refusing the same due to financial constraints, expected prolonged hospital stay, lack of social support and logistical issues.

Disclosure

All authors have declared no conflicts of interest.