Running head: LEUKEMIA TREATMENT

The Burden of Paying for Leukemia Treatment Needs to be Lessened Gabby Callaghan Academy for the Arts, Science, and Technology

LEUKEMIA TREATMENT The Cost of Leukemia Treatment is too High for the Results it Produces Leukemia, in laymans terms, is essentially cancer of the blood cells: erythrocytes, leukocytes, and lymphocytes. Leukemia begins in the bone marrow; the marrow produces a significant amount of abnormal white blood cells, called leukemia cells. Over time, these abnormal cells begin to overtake the normal blood cells, and this causes anemia, infections, and

other complications associated with this disease (Healthwise). Leukemia is mostly seen in young children and middle-aged or elderly people. The most common forms of leukemia in the elderly are Acute Myelogenous Leukemia (AML), Chronic Lymphocytic Leukemia (CLL), and Chronic Myelogenous Leukemia (CML) (Healthwise). The average cost for the treatment of these types of leukemia ranges from $25,000 and upwards. Through research, one can come to the conclusion that the cost of treating leukemia is too high when the effectiveness of the treatment is evaluated, and not enough is being done for patients that need help paying medical bills. Chemotherapy Costs Depending on the type of chemotherapy, prices can range from $100 a treatment to $30,000 a treatment. Patients that receive the treatment in the hospital would obviously receive higher cost than a patient receiving chemo in-home. Between 1991 and 2002, the average cost of chemotherapy has gone up between $4,000 and $7,000. The introduction of new and more effective drugs is easily contributing to the higher cost of treatment. Some patients are also opting out of receiving chemotherapy because insurance companies are not reimbursing the patients for treatment (Ghosh, 2013).

LEUKEMIA TREATMENT Blood Transfusions Basic blood transfusions are needed when someone is low in different components of blood, such as red blood cells or platelets. Cancers such as leukemia, lymphoma, and myeloma

may require blood transfusions throughout the course of treatment. These cancers affect the bone marrow, which in turn prevent the normal production of red blood cells, white blood cells, and platelets. In addition, chemotherapy radiation can also cause a decrease in cell counts; when it kills the leukemia cells in the bone marrow, normal cells are also killed. Complications from low platelets can be prevented with blood transfusions. In conclusion, most leukemia, lymphoma, and myeloma patients will need a blood transfusion at some point during treatment (Raymaakers). Cost and Cost-Effectiveness This study involved 517 cancer patients that received blood from 1995-1996. All of the direct and indirect costs were evaluated for each patient, and the average costs were computed from the compilations of costs. This study found that in 1998 dollars, the average cost per unit of red blood cells was $469 ($673in 2013) for adults and $568 ($815) for pediatric patients. As most adult patients would receive two units of blood, the cost for a two unit transfusion would be $938 ($1,346). Patients with tumors in their blood required more units per year, which was approximately a $50 ($72) increase in price. The study concluded that the cost of outpatient red blood cell transfusion was higher than in was in past years, which suggests that the cost would only continue to increase in the future. Additionally, this source also concluded that an RBC transfusion was not entirely cost-effective (Barrett, Anderson &Slavin).

LEUKEMIA TREATMENT Chronic Lymphocytic Leukemia Chronic Lymphocytic Leukemia is a fatal disease that occurs mainly in patients over 60. Among other forms of leukemia, cases of chronic myeloid leukemia, a highly curable form of leukemia, are increasingly going either undertreated or untreated because of the rising cost of

treatment. CML just recently became a highly curable form of leukemia when powerful therapies known as tyrosine kinase inhibitors were introduced more than ten years ago. These easilyabsorbed pills target CML and helps manage the disease with minor side effects. Just ten years after this drug has been introduced, the mortality rate of CML has declined to almost 2%, a huge breakthrough in medicine. With this new therapy, chronic myeloid leukemia can almost be managed in a similar manner to the management of diabetes and hypertension (American Society of Hemotology). Costs These great results, however, come at a price. It has been noted that among 12 new drugs approved by the FDA to treat different types of cancer, 11 of them came at a cost of over $100,000 a year, on average $10,000 a month. Thats a 100% increase in price from a little over a decade ago, when most cancer treatments hovered at around $5,000 a month. This is putting an outrageous strain on households, where out-of-pocket cancer care take about 30% of the average annual household income. While the average survival rate of all CML cases is currently at about 60%, one can assume that the other 40% has lacked in proper treatment, more than likely because of lack of adequate funds to pay for treatment (American Society of Hemotology).

LEUKEMIA TREATMENT Acute Myeloid Leukemia As most of the population begins to age, the cases of acute myeloid leukemia are expected to rise. A study was conducted to collect data and treatment costs to help to make the public aware of the costs and treatment practices of AML, and the results are described in this

scholarly article. Survival rates, use of health care resources, use of chemotherapy, and Medicare payments were all evaluated among 2657 patients. These patients were all of 65 years of age and older, and all had an initial diagnosis of AML between January 1, 1991 and December 31, 1996. The median survival rate of these patients came back to be very poor; after diagnosis, there was a 2 year, 2 month survival rate of 6%. (Menzin, Lang, Earle &Kemey). Costs Medicare paid a mean $41,594 per patient for treatment. 790 of the patients had chemotherapy treatment, which raised the costs about 3 times higher than patients that did not receive chemotherapy. Those who elected to have chemotherapy also increased their survival time by approximately 6 months. The article concluded that AML can be directly associated with a poor survival rate and outrageous costs for such a small amount of the remaining months of life. Most patients dont even receive chemotherapy treatment, so the article concluded that further work is needed to characterize this disease and the patient-related factors that influence treatment decisions and associated health outcomes (Menzin, Lang, Earle &Kemey). Conclusion The burden of paying for leukemia is easily lessened if the patient takes the correct steps. Essentially, patients with any type of leukemia are under-educated on the resources they have to pay for their treatment costs. It is important for patients to know certain points about insurance

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coverage that they have before undergoing chemotherapy such as: making sure they are aware of new treatments, making sure there is no limit to the selection of drugs that can be used, and making sure there are no restrictions on drugs that are not approved by the FDA. Medicaid will also assist in the payment of chemotherapy, but the application takes months to process, so applying early is recommended.

LEUKEMIA TREATMENT References

Ghosh, R. (Aug 2013). The Average Cost for Cancer Chemotherapy Treatment. Retrieved from: http://www.livestrong.com/article/153376-the-average-cost-for-cancer-chemotherapy-treatment/. On 10/4/13 American Society of Hematology. (2013, April 25). Leading Leukemia Experts: High Leukemia Treatment Costs May Be Harming Patients. Blood. Retrieved from http://www.hematology.org/News/2013/10454.aspx. On 9/13/13 Menzin J., Lang, K., Earle, C., Kerney, D. (2002 July). The Outcomes and Costs of Acute Myeloid Leukemia Among The Elderly. Retrieved from: http://archinte.jamanetwork.com/article.aspx?articleid=212343. On: 10/3/2013. Barrett, B., Anderson, K., Slavin, Mitchell. (2000). Cost of Outpatient Blood Transfusion in Cancer Patients. Retrieved from: http://jco.ascopbs.org/content/18/14/2755.full. On: 10/4/1 Raymaakers, K. (2010 November). Blood Transfusions for Leukemia and Lymphoma Patients Retrieved from: http://lymphoma.about.com/od/livingwithleukemia/qt/Blood-Transfusions-ForLeukemia-And-Lymphoma-Patients.htm. On: 10/4/13 Web MD. (2011 June). Leukemia Topic Overview. Retrieved from: http://www.webmd.com/cancer/tc/leukemia-topic-overview . On 11/26/13