Retrospective survival analysis and cost-effectiveness evaluation of second allogeneic bone marrow transplantation in patients with acute leukemia

The therapeutic options for patients with acute leukemia who relapse after the initial transplant include second bone marrow transplantation (2BMT) an d conventional chemotherapy (CC), In this work, we conducted an analysis of published survival data and we evaluated the cost-effectiveness of 2BMT in comparison with CC. We retrieved survival information on 167 patients trea ted with 2BMT and 299 patients treated with CC. Survival figures were deriv ed from individual patient data and were compared between 2BMT and CC. The mean lifetime survival (MLS) was estimated for each of the two patient coho rts using standard techniques of survival-curve extrapolation, The cost dat a of patients given 2BMT or CC were estimated from published data. Our anal ysis of individual survival data showed that 2BMT improved survival at leve ls of statistical significance (survival gain = 19.6 months per patient). U sing an incremental cost of $90 000 per patient, the cost-effectiveness rat io of 2BMT in comparison with CC was calculated as $52 215 discounted dolla rs per discounted life year gained. Our results indicate that, in patients with acute leukemia who relapse after their first transplant, 2BMT signific antly prolongs survival in comparison with CC and seems to have an acceptab le cost-effectiveness profile.