OBJECTIVES: Hematopoietic stem-cell transplantation(HSCT) is considered an important treatment strategy in medically eligible acute myeloid leukemia(AML) patients, but the cost is substantial. This study aimed to estimate the hospitalization costs and follow-up costs of HSCT procedure in AML patients.

METHODS: We analyzed national claims data from the Health Insurance Review and Assessment Service database covering the entire AML population in Korea. Patients were selected with the first diagnosis of primary AML(ICD-10 code: C92-C96) between January 2011 and August 2018 without any AML history in the previous three years. We defined patients receiving HSCT based on the procedure code “X513*”. The post-HSCT was classified into two groups: 1) Transplant completion group with code “Z948(other transplanted conditions)” and 2) Transplant failure group with code “T86(transplant rejection status)”. The HSCT cost was calculated as the average medical expenses incurred from the time the patient was hospitalized for procedure until discharge. Post-HSCT costs were measured as annual medical expenses incurred in the first and second years after procedure in surviving patients.

RESULTS: We identified 2,177 patients (mean age 40.9 years, 46.0% of females) receiving HSCT among primary AML. The estimated cost of HSCT procedure was USD 30,597. After HSCT, the number of patients in transplant completion group was 683 (31.4%). The annual costs of post-HSCT were USD 11,327 (n=549) for the first year and USD 1,680 (n=507) for the second year. The number of patients in transplant failure group was 1,111 (51.0%), and follow-up costs for the first year were USD 17,616 (n=858), and USD 7,126 (n=744) for the second year.

CONCLUSIONS: Half of AML patients failed HSCT, resulting in high follow-up costs. Moreover, even if receiving procedure, 32% of patients died within two years. This study indicates a need to develop new strategies to effectively manage AML patients who received HSCT, which might bring lower medical costs.