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The Outcomes and Costs of Acute Myeloid Leukemia Among the Elderly
Joseph Menzin, PhD;
Kathleen Lang, PhD;
Craig C. Earle, MD;
Donna Kerney, PhD;
Rajiv Mallick, PhD
Arch Intern Med. 2002;162:1597-1603.
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.
From Boston Health Economics, Inc, Waltham, Mass (Drs Menzin, Lang,
and Kerney); the Dana-Farber Cancer Institute, Boston, Mass (Dr Earle); and
Wyeth-Ayerst Research, Collegeville, Pa (Dr Mallick).
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