Introduction: Older people with acute myeloid leukaemia (AML) have a poor prognosis, reduced health-related quality of life (HRQoL) and require substantial healthcare resources. Referral to specialist palliative care (SPC) for symptom management, psychosocial care, and advance care planning has been reported as cost-effective for people with advanced cancer, but has not been explored for older people with AML. 

Aim: To investigate whether early referral to SPC may be cost-effective when compared with standard care for people >60 with newly diagnosed AML.

Methods: A modelled cost-utility analysis was conducted, from an Australian public healthcare system perspective, over a five-year time horizon. A systematic review of studies reporting HRQoL (appropriate for use in economic evaluation) of people >60 years with AML provided the values for the decision tree model. Cost and effectiveness data were sourced from a broad review of the literature. Different scenarios, and sensitivity analyses explored the impact of varying key assumptions on the results.

Results: Only 4/494 (0.81%) of the studies screened in the systematic review contained relevant HRQoL data. For the base case (main scenario), SPC was associated with incremental cost saving (-$4,597) and fewer incremental quality-adjusted life years (QALYs) (-0.04). In one-way sensitivity analysis, results were sensitive to utility values in treatment-related health states. In various scenarios and probabilistic sensitivity analysis, SPC was cost-effective or dominated standard care.

Conclusion: The base case findings suggest early SPC is likely to be cost saving but less effective than standard care. However, in analyses of different scenarios SPC was dominant with fewer costs and more QALYs. Results must be interpreted cautiously given the uncertainty of inputs in the model due to lack of published evidence on HRQoL of older people with AML that can be used in economic evaluation. Findings warrant further research to inform future models of care.