The long shadow of socioeconomic deprivation over the modern management of acute myeloid leukemia: time to unravel the challenges

Abstract

Biological and non-biological variables unrelated to acute myeloid leukemia (AML) preclude standard therapy in many settings, with “real world” patients under-represented in clinical trials and prognostic models. Here, using a case-based format, we illustrate the impact that socioeconomic and anthropogeographical constraints can have on optimally managing AML in 4 different healthcare systems. The granular details provided, emphasize the need for the development and targeting of socioeconomic interventions that are commensurate with the changing landscape of AML therapeutics, in order to avoid worsening the disparity in outcomes between patients with biologically similar disease.

Quantitative cost‑effectiveness index of cancer treatments

“…Currently, in the USA, the total mean episode costs are highest in relapsed/refractory (R/R) episodes ($439,104), followed by hematopoietic stem cell transplantation ($329,621) and high-intensity chemotherapy ($198,657) ( 24 , 25 ). Such an economic burden is too heavy for numerous families, particularly those in developing countries ( 26 ). The comprehensive evaluation of the treatment efficacy and expense is crucial to therapy treatment.…”

Shaping the AML Treatment Landscape—Modeling a Path through Plenty, Uncertainty, and Paucity

“…In lowand middle-income countries, financial constraints often render therapies, considered "standard-of-care" in higher income countries, prohibitively expensive. 6 Increasingly, the rarity of biological subtypes of AML 1 and the availability of multiple drugs targeting unique disease sub-types 2,5,7,8 are also beginning to present challenges to the design of contemporaneous clinical trials. To optimize clinical benefits and the cost-effectiveness of therapy to patients and healthcare systems, as well as to address key clinical hypotheses, an innovative approach for hypothesis testing and identifying best therapy is, therefore, required.…”

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“…In lowand middle-income countries, financial constraints often render therapies, considered "standard-of-care" in higher income countries, prohibitively expensive. 6 Increasingly, the rarity of biological subtypes of AML 1 and the availability of multiple drugs targeting unique disease sub-types 2,5,7,8 are also beginning to present challenges to the design of contemporaneous clinical trials. To optimize clinical benefits and the cost-effectiveness of therapy to patients and healthcare systems, as well as to address key clinical hypotheses, an innovative approach for hypothesis testing and identifying best therapy is, therefore, required.…”