OBJECTIVES: Most patients with acute myeloid leukemia (AML) experience disease relapse after remission, and many are not candidates for curative hematopoietic stem cell transplantation (HSCT). Using real-world cost estimates, we sought to quantify the economic burden of relapse in patients with AML who attain remission.

METHODS: We performed a retrospective cohort study of adults with newly diagnosed AML who attained remission following induction therapy and experienced relapse between July 1, 2012, and September 30, 2019. IBM MarketScan Commercial and Medicare Supplement Databases were used. Eligible patients had ≥2 outpatient AML claims within 90 days or ≥1 inpatient claim during the study period, were continuously enrolled for ≥180 days pre-index (the date of the first AML claim), and had not received an HSCT. Costs were calculated using a per-patient-per-month (PPPM) metric, adjusted to 2020 US dollars.

RESULTS: Of 18,013 patients with AML claims, 193 met the selection criteria (median age 58.0 years), among whom 69% had commercial insurance and 31% had Medicare coverage. The median times from diagnosis and from first-line treatment initiation to remission were 59 and 49 days, respectively. The median times from remission to relapse and from relapse to end of follow-up were 147 and 160 days, respectively. Mean all-cause costs (PPPM) during the remission and relapse periods, respectively, were $12,697 and $25,818 for hospitalization, $11,192 and $10,679 for outpatient visits, and $2607 and $3856 for total outpatient drug costs. Mean total all-cause costs (PPPM) during these periods were $26,088 and $40,353, respectively, reflecting an incremental cost of relapse of $14,265 (P=0.0002).

CONCLUSIONS: Among patients with AML who were ineligible for HSCT, disease relapse incurred sizeable incremental costs and imposed a heavy economic burden. Given that maintenance therapy may prolong remission and reduce relapse-related costs, future research evaluating the economic impact of maintenance therapy is warranted.