[A program for medical use of information systems. Validity of calculation of direct costs for the initial treatment of acute myeloblastic leukemia]. / Programme de médicalisation des systèmes d'information. Validité du calcul des coûts directs pour le traitement initial de la leucémie aiguë myéloblastique.

In order to validate the information systems medicalization program used since 1984 at the Hôtel-Dieu hospital, Paris, the direct costs given by this program were compared with those calculated from the medical records of 10 adult patients hospitalized for diagnosis and treatment of acute myeloblastic leukaemia. The mean direct cost of an 8 to 81 days hospital stay was estimated at 75.393 +/- 41.260 French francs by the program and 84.969 +/- 52.288 FF by calculations from the records. A fairly good correlation (r2 = 0.72; P = 0.002) was found between the 2 evaluations. There was no statistically significant difference between the figures obtained by the 2 methods, except for pharmaceutical expenditures (P = 0.005) which were grossly underevaluated by the program. A better correlation could be obtained if an attribution of drugs and transfusions per patient was entered in the program.

Cost of complete remission induction in acute myeloblastic leukemia: evaluation of the cost-effectiveness of a new drug.

The use of new drugs in the treatment of AML could dramatically increase the cost of induction chemotherapy. To evaluate the cost-effectiveness of such new drugs, the overall cost to achieve complete remission (CR) with treatments including these drugs has to be compared to the cost of the daunorubicin-cytosine arabinoside (DNR-AraC) association, considered as the reference treatment. A retrospective analysis of charts from 15 patients treated with DNR-AraC was used to identify 228 items of cost, including general cost, diagnostic, supportive care, and chemotherapy. Eleven patients underwent CR after one course of chemotherapy for a cost of US$16,701 +/- 4451, and four patients achieved CR after two courses for a cost of US$37,130 +/- 4923. The chemotherapy represented only 1.4% of the total cost, supportive care 25% and general cost 56%. According to these data, the projective cost of a treatment with mitoxantrone instead of DNR was simulated in 40 untreated patients with AML. The better rate of CR obtained after one course of chemotherapy leads to a saving of 9% (US$1261) per patient, despite the higher cost of chemotherapy. Cost-effectiveness evaluation should be included in the clinical study of trials with new drugs.