IDARUBICIN - A PHARMACOECONOMIC EVALUATION OF ITS USE IN ADULT PATIENTS WITH ACUTE MYELOID-LEUKEMIA

Idarubicin is an effective agent in the treatment of acute myeloid leu kaemia (AML), inducing complete remission in 39 to 80% of newly diagno sed patients. Although it also demonstrates efficacy as monotherapy, a nd is of use in relapsed or refractory disease, most comparative clini cal trials have administered idarubicin intravenously in combination w ith cytarabine in newly diagnosed patients. These trials indicate that improved survival and response rates, and rapid achievement of remiss ion, are more likely with idarubicin than with daunorubicin, when both agents are given in combination with cytarabine. In elderly patients, however, response rates are lower than in younger patients, and there is less disparity in efficacy between idarubicin and daunorubicin ind uction therapy. Although AML is an expensive disease to treat, the maj ority of costs are associated with the length of hospitalisation. with the acquisition cost of the chemotherapy agents contributing < 10% to overall expenditure. Idarubicin combined with cytarabine therapy achi eved higher response rates with the first cycle of therapy than daunor ubicin. thereby reducing the requirements for a second cycle of therap y and further hospitalisation. Compared with daunorubicin plus cytarab ine induction treatment, idarubicin plus cytarabine reduced the costs of achieving a complete response by between 22 and 39% in patients wit h a median age < 60 years, In patients with a median age of 62 years, who are more representative of the AML population, costs of achieving a complete response were reduced by 3 to 6%. Thus, idarubicin is more cost effective than daunorubicin as induction therapy in combination w ith cytarabine, in adult patients with AML. The pharmacoeconomic posit ion of idarubicin in postinduction therapy remains to be established.