Cost benefit analysis of treatment for acute myelogenous leukaemia

Although the rise in health costs is a widely debated issue, in Switzerland it was until recently taken for granted that patients are given the best a vailable treatment regardless of cost. An example of a disease requiring co stly treatment is acute myelogenous leukaemia (AML). To relate cost to bene fit we calculated expenditure per life years gained. To assess costs we det ermined the real cost of treatment up to total remission, followed by conso lidation or withdrawal of treatment or death. For survival time exceeding t he 2-year observation period we used data from recent literature. The avera ge cost of treatment ranges up to 107 592 Swiss francs (CHF). In 1997 we tr eated 23 leukaemia patients at Zurich University Hospital and gained a tota l of 210 life years. This represents an average cost of CHF 11 741 per life year gained. Chief cost items were therapy and personnel costs for nursing staff, followed by hotel business and personnel costs for doctors and diag nosis. Our results for AML treatment are far removed from the $61 500 rangi ng up to $166 000 discussed in the literature as the "critical" QALY (quali ty adjusted life years) value. This is the first time the actual costs of A ML therapy have been shown for a Swiss cohort. Despite high initial treatme nt costs and success only in a limited number of patients, the expenditure per QALY is surprisingly low and shows clearly the effectiveness of apparen tly costly acute medicine.