Costs Associated With Induction Chemotherapy In Adult Acute Myeloid Leukemia (Aml) Managed In A Tertiary Care Specialized Unit.

e18503 Background: Induction chemotherapy with cytarabine/anthracycline remains the standard for AML. Regimen-related toxicities and profound myelosuppression lead to a prolonged hospitalization. In a specialized leukemia unit, a team of dedicated providers can deliver cost-effective care using streamlined processes Methods: Analysis of costs of hospitalization for induction in an academic center leukemia unit. Results: Between 1/2006 - 7/2011, 110 consecutive adult AML patients (pts) received induction. Median age was 60 (19-79), median white blood cell count (WBC) was 18.7 x103/mcL (0.3-348), with WBC ≥ 100 x103/mcL in 17. Cytogenetic (CTG) risks were favorable in 21%, intermediate in 47%, unfavorable in 29%, and unknown in 3%; 22 had secondary AML. Length of stay (LOS) was 28 d (9-56), and 12% required ICU care for a median of 3 d (2-17). Overall, 36% required 1, and 24% ≥ 2 consultations from non-hematology specialists. Median follow-up for survivors is 78 months (60-110). 30 d survival was 94%, mortality was 0 vs. 13% for pts < vs. ≥ 60 (p = 0.013), 4 vs. 18% for WBC < vs. ≥ 100 (p = 0.03), and 23% (vs. 4%) for pts requiring ICU care. Age was the only significant predictor of early death by MVA (p = 0.018). OS was 53 vs. 38% for pts < vs. ≥ 60 (p = 0.04), 51 vs. 23% for de novo vs. secondary AML (p = 0.001), and 74, 50, and 22% for favorable, intermediate and high-risk CTG (p = 0.001). Age (p = 0.04), CTG (p = 0.005) and ICU care (p = 0.017) were predictors of OS by MVA. Median hospitalization cost was $58,065 (8,493-442,349), and was affected by LOS (p < 0.001) and the need for ≥ 2 consultants (p = 0.025). Cost for < 20 d LOS was $33,289 (8,493-42,172), $58,370 (10,666-299,991) for 20-39 d, and $80,007 (13,379-124,180) for ≥ 40 d. Costs for pts not requiring consultation from a non-hematologist were $56,395 (8,493-100,766); $56,805 (10,666-299,991) and $72,981 (13,379-$182,311) for those requiring 1 vs. ≥ 2 consultants, respectively. Conclusions: We have reported costs associated with induction for AML in a specialized unit. These costs can serve as benchmark for comparisons. The number of non-hematologists consulted and LOS, both surrogate markers of complexity, were the major drivers of these costs.