CYTOGENETIC AND MOLECULAR-BIOLOGY FOR ACUTE LEUKEMIAS AT DIAGNOSIS - A COST EFFECTIVENESS COMPARISON/

This article presents a cost-effectiveness study comparing cytogenetic and molecular analyses for detection of chromosomal abnormalities whi ch are prognostic factors in acute leukemia. The aim of the study was to determine how these two techniques could substitute or complement o ne another. The study sample consisted of 107 adult patients with de n ovo myeloid or lymphoid acute leukemias, tested by both techniques in 1994 and 1995, for identification of translocations t(9;22), t(8;21), t(15;17), t(4;11), t(1;19), the inversion of chromosome 16 and for mon osomy 5 or 7 (or deletion of their long arms:) and trisomy 8, The crit erion for diagnostic effectiveness of these strategies was the rate of detection of true positive anomalies which are clinically relevant, a ccording to the current state of knowledge, On the basis of these obse rvations six alternative strategies at diagnosis were compared (each t echnique alone or different combinations of the two techniques). The s tudy shows that,-for ALL, PCR alone appears the most cost-effective st rategy;-for AML, cytogenetic analysis alone is the best strategy;-sequ ential strategies are more cost effective than simultaneous use of bot h techniques for minimising risk of false negatives.