Dr Jeffrey Lancet on the Balance Between Cost and High Quality Care in AML

Jeffrey E. Lancet, MD, chair of the Department of Malignant Hematology at Moffitt Cancer Center, discussed the issue of cost and optimizing patient outcomes acute myeloid leukemia (AML).

Transcript

What are some considerations when it comes to the balance between cost and optimizing patient outcomes in AML treatment?

I think a lot of it depends on, what is the impact of changing the treatment paradigm from inpatient based treatment to outpatient based treatment? And I feel like we're going to need more studies to really understand that.

Historically, the majority the cost of care in AML is related to hospitalizations. It may sound great that we're moving away from hospitalizations, and it is great—we don't want people in the hospital because it's a bad place to be when it comes to losing your strength and recovery and being away from family. But, you know, if we have alternative therapies that are extremely expensive, then the cost may actually end up being higher in the long run, than the cost of a hospitalization may be more limited. But I think that also implies that people are living longer. When you have successful therapy, that costs more, that usually means that patients are having better outcomes. Of course, we want that—there's no price you can put on that. We're always looking to improve survival, remission duration, and so forth. But it's important to be cognizant of the cost associated with doing that.

To that end, it's important to understand the duration of therapy that's optimal for these patients to maintain the best response so that we can be good stewards of the resources that we have and make sure that patients are being treated in a responsible way that doesn't create insurmountable financial barriers. For example, we need to understand what is the overall benefit of indefinite therapy for a patient as opposed to more limited, defined time point therapy that might be just as good for patient outcomes than giving patients chronic treatment for the rest of their lives when you may not need to do that.

We don't have the answers to those questions yet, but they're very important studies to be addressed to help us understand the best possible way to get patients off of treatment as soon as they can to eliminate risks and side effects, but also to contain medical costs that go along with continuous ongoing therapy—if it's not necessary. I think we're seeing examples of that type of approach being taken right now and other types of blood cancers. For example, in chronic myeloid leukemia, there are now good data to suggest that maybe half of patients can come off of treatment altogether someday if they achieve a very, very deep remission.

Therapy for chronic lymphocytic leukemia is also looking at more limited time therapy as an option with novel combinations. So I think the same thing has to be applied to AML. One of the problems with AML is we haven't quite achieved that level of success as we've seen in these other cancers. So right now, we're still battling the concept of helping people live longer, because right now, AML still has a very poor prognosis in general. The prognosis is measured in months, not years. But still, as we get better and more refined than our treatment, and people are living longer, then we have to really make a concerted effort to understand the duration of therapy that is necessary to achieve maximum response without breaking the bank.