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Treatment Pattern, Financial Burden, and Outcomes in Elderly Patients with Acute Myeloid Leukemia in Korea: A Nationwide Cohort Study

Author

Listed:
  • Hyerim Ha

    (Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea
    These authors contributed equally to this work.)

  • Yujin Jeong

    (Department of Biostatistics, Korea University College of Medicine, Seoul 02841, Korea
    These authors contributed equally to this work.)

  • Joo Han Lim

    (Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea)

  • Young Ju Suh

    (Department of Biomedical Sciences, College of Medicine, Inha University, Incheon 22332, Korea)

Abstract

Although approximately 50% of patients with acute myeloid leukemia (AML) are diagnosed over the age of 60 years, there is currently no established consensus on the treatment of elderly AML patients. Herein, we aimed to explore the incidence, medical expenditure, treatment, and outcomes of elderly AML patients in Korea by analyzing a nationwide cohort. We employed the Korean National Health Insurance Service-Senior cohort, which represents 10% of a random selection from a total of 5.5 million subjects aged 60 years or older. AML patients were identified according to the main diagnostic criteria of acute leukemia. Treatment for AML was divided into high- (high-dose cytarabine ± idarubicin) and low- (low-dose cytarabine or hypomethylating agents) intensity chemo-therapy and classified according to the chemotherapeutics protocol. We analyzed the survival outcomes and medical expenditures. Among 558,147 elderly patients, 471 were diagnosed with AML, and 195 (41.4%) were treated with chemotherapy. The median age was 65 years, and the median overall survival (OS) was 4.93 months (95% confidence interval, 4.47–5.43). Median OS was longer in patients undergoing chemotherapy than those in the best supportive care group (6.28 vs. 3.45 months, p < 0.001), and the difference was prominent in patients aged < 70 years. Twenty-eight (5.9%) patients received high-intensity chemotherapy, while 146 (31.0%) received low-intensity chemotherapy. The difference in median OS according to dose intensity was 4.6 months, which was longer in the high-intensity chemotherapy group (9.8 vs. 5.2 months in low-intensity group); however, the difference was not statistically significant. Patients who received high-intensity chemotherapy recorded longer hospital stays and incurred greater expenses on initial hospitalization. Elderly AML patients in Korea exhibited clinical benefits from chemotherapy. Although patients should be carefully selected for intensive treatment, chemotherapy, including low-intensity treatment, can be considered in elderly patients. Moreover, prospective studies on new agents or new treatment strategies are needed.

Suggested Citation

  • Hyerim Ha & Yujin Jeong & Joo Han Lim & Young Ju Suh, 2022. "Treatment Pattern, Financial Burden, and Outcomes in Elderly Patients with Acute Myeloid Leukemia in Korea: A Nationwide Cohort Study," IJERPH, MDPI, vol. 19(4), pages 1-13, February.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:4:p:2317-:d:751860
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    References listed on IDEAS

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    1. Juliana Meyers & Yanni Yu & James Kaye & Keith Davis, 2013. "Medicare Fee-for-Service Enrollees with Primary Acute Myeloid Leukemia: An Analysis of Treatment Patterns, Survival, and Healthcare Resource Utilization and Costs," Applied Health Economics and Health Policy, Springer, vol. 11(3), pages 275-286, June.
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