OBJECTIVES: This study aims to identify the economic burden associated with end-of-life care in Acute Myeloid Leukemia (AML) patients, a hematologic malignancy recognized for its substantial end-of-life costs.

METHODS: This longitudinal retrospective cohort study, employing the Health insurance Review and Assessment Service databases from January 2008 to August 2020, representing over 98% of the Korean population. The incident AML patients were defined with the first diagnosis of AML (ICD-10 code: C92-95 excluding C92.1, C92.2, C92.3, C94.4, C94.5, C94.6) between 2010 and 2020, with no AML history during the 2-year washout period. The AML decedents were defined with the coded death in the insurance claims. The study defined end-of-life as the healthcare resource utilization cost in the last year of life from 2011 to 2020, and any patients without claim history for the last year of life were excluded

RESULTS: A total of 12,104 AML decedents (mean age: 62.30 years) were identified, including 7,016 male patients (57.79%). Among those, 1,255 patients (10.34%) received hematopoietic-stem-cell-transplantation (HSCT), and the average Charlson Comorbidity Index (CCI) was 4.19. 54.51% of the population received treatment in tertiary hospitals, and 92.81% of population were health insurance payers. The others were under Medicaid or the Veterans’ scheme. The average end-of-life cost was $50,763 per patient, including hospitalization, emergency visits, outpatient visits, and prescribed drug, with out-of-pocket payment constituting 6.29% of the total cost. The patient with HSCT history was 2.15 times higher end-of-life costs than those without. Over the decade, the end-of-life cost saw an upward trend, increasing on average by 5% per year. In 2020, the most recent year of the study, the highest end-of-life cost reached $62,425 per patient.

CONCLUSIONS: End-of-life costs were increasing about 50% over the decade. Notably, it was found that patients with AML who underwent hematopoietic stem cell transplantation (HSCT) experienced significantly higher end-of-life costs.