Economic Burden of Transplantation in Acute Myeloid Leukemia Patients in European Union: Results from a Systematic Review of Literature

OBJECTIVES: Acute Myeloid Leukemia is a heterogenous malignancy whose management is associated with considerable healthcare resource utilization and high expenditures because of recurrent and extended hospitalizations, multiple outpatient visits, and a wide range of supportive care. Hematopoietic stem cell transplantation is a potentially curative treatment modality, which provides long-term remission, but the patients might suffer from loss of income or high out-of-pocket expenditure. Few studies have addressed the expenses and burden of AML. Most of these studies were conducted in the USA. Very little work is available in the European Union. The objective of this study is to assess the economic burden associated with transplantation in AML patients and determine the major cost-driving factors in the European Union (EU).

METHODS: We systematically reviewed the PUBMED, Embase, ScienceDirect, SCOPUS, and Google Scholar-indexed English-language literature. We used following keywords for literature retrieval: Acute Myeloid Leukemia, economic burden, direct cost, healthcare resource utilization and transplantation. We identified studies evaluating economic burden of transplantation in AML patients in 5 countries of the European Union, published before April 15, 2024. Study characteristics and cost information were extracted. The treatment cost per patient was calculated, and the results were converted into 2024 Euros.

RESULTS: Twenty-one studies met our inclusion criteria. The mean per-patient direct costs of transplantation in Sweden, Austria, France, Netherlands and Spain were €185423.36, €181404.43, €127401.55, €118168.70 and €46173.90 respectively. The cost-driving factors associated with AML treatment were inpatient hospitalization and medication costs.

CONCLUSIONS: AML seems to incur substantial direct economic expenses. Reducing the days of hospitalization can significantly decrease the economic burden of AML in the European Union. Moreover, there is a necessity for studies that comprehensively evaluate the economic implications, particularly concerning total and indirect costs.