|Acute leukemia is a serious disease with high mortality rate and high costs of treatment. In Thailand, currently used treatment protocols varied greatly because of hospitals’ resource and budget constrains; this could affect treatment outcomes. The objective of this study was to determine direct medical costs and treatment outcomes of acute leukemia patients in Sappasittiprasong hospital.
The study was a descriptive study using retrospective database. Newly diagnosed acute leukemia patients, admitted at Sappasittiprasong hospital from October 1, 2004 to September 30, 2006, were followed up until April 30, 2008. The treatment outcomes data collected for 2 years of treatment and the cost data collected for 1 year of treatment.
As a result, 151 acute leukemia patients were enrolled; 45 were children; 106 were adult. Of 45 child patients, all received chemotherapy, 35 (77.80%) were ALL, 8 (17.80%) were AML, 2 (4.40%) were APL. Treatment outcomes of child patients with ALL, AML, and APL were as followed= complete remission rate were 85.71%, 37.50% and 100%; relapsed rate were 6.70%, 0% และ 0%; 2-years survival rate were 68.57%, 37.50% and 100%. Median survival time in AML was 7.53 months. Of 106 adult patients, 16 (15.40%) were ALL, 8 (7.50%) were APL; all ALL and APL patients received chemotherapy. Of 82 (77.40%) adult AML patients, 64 cases received chemotherapy, 11 cases received palliative chemotherapy, 7 cases received no chemotherapy. Treatment outcomes of adult patients with ALL, AML , and APL, who received chemotherapy were as followed= complete remission rate were 31.30%, 32.81% and 62.50%, relapsed rate were 40.00%, 47.62% and 60%, survival rate were 6.25%, 4.69% and 25%, median survival time were 3.50, 2.87 and 14.47. Median survival time in adult AML patients receiving palliative chemotherapy and no chemotherapy were 0.57 and 1.03 months, respectively. Median direct medical costs for child with ALL, AML, and APL, who received chemotherapy, were 56,293, 104,557 and 110,495 bath; first-year costs were 166,544, 366,147 and 360,647 baht. Median direct medical costs for adult with ALL, AML, APL, who received chemotherapy, were 56,293, 104,557, and 110,495 baht; first-year costs were 115,911, 349,658, and 169,904 baht. Median direct medical costs for adult AML patients receiving palliative chemotherapy and no chemotherapy were 22,660 and 9,080 baht, respectively.
Conclusion= The costs and treatment outcomes of patients with acute leukemia in Sappasittiprasong hospital varied by type of acute leukemia, treatment protocols and chemotherapy regimen. Since child patients with acute leukemia have high overall survival rate than adult ones, period of study to determine survival time for child patients with acute leukemia should be extended more than 2 years. We found lower overall survival rates than previous studies; this may cause underestimation of costs of treatment in our study. Moreover, most patients died during induction phase due to febrile neutropenia. Thus, to improve disease management and increase patient survival rates, more studies should be conducted to determine factors associated with costs of treatment and treatment outcomes, and to analyze cost-effectiveness of acute leukemia treatment protocols.