Idarubicin: a pharmacoeconomic evaluation of its use in adult patients with acute myeloid leukaemia.

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Idarubicin is an effective agent in the treatment of acute myeloid leukaemia (AML), inducing complete remission in 39 to 80% of newly diagnosed patients. Although it also demonstrates efficacy as monotherapy, and is of use in relapsed or refractory disease, most comparative clinical trials have administered idarubicin intravenously in combination with cytarabine in newly diagnosed patients. These trials indicate that improved survival and response rates, and rapid achievement of remission, are more likely with idarubicin than with daunorubicin, when both agents are given in combination with cytarabine. In elderly patients, however, response rates are lower than in younger patients, and there is less disparity in efficacy between idarubicin and daunorubicin induction therapy. Although AML is an expensive disease to treat, the majority of costs are associated with the length of hospitalisation, with the acquisition cost of the chemotherapy agents contributing less than 10% to overall expenditure. Idarubicin combined with cytarabine therapy achieved higher response rates with the first cycle of therapy than daunorubicin, thereby reducing the requirements for a second cycle of therapy and further hospitalisation. Compared with daunorubicin plus cytarabine induction treatment, idarubicin plus cytarabine reduced the costs of achieving a complete response by between 22 and 39% in patients with a median age less than 60 years. In patients with a median age of 62 years, who are more representative of the AML population, costs of achieving a complete response were reduced by 3 to 6%. Thus, idarubicin is more cost effective than daunorubicin as induction therapy in combination with cytarabine, in adult patients with AML. The pharmacoeconomic position of idarubicin in postinduction therapy remains to be established.