Acute Myeloid Leukemia (AML) disproportionately affects older patients. Mortality rates are high, and treatment often requires multiple hospitalizations, including those with chemotherapy. Nonetheless, treatment pathways for older AML patients are not well understood. The objective of this study is to characterize hospitalizations, mortality, and chemotherapy treatment in the US for older adults with newly diagnosed AML.

We used 2010-2012 Medicare Limited Data Set files to identify patients with newly diagnosed AML (ICD-9 205.0) who were continuously enrolled in Medicare Fee-for-Service for 6+ months before and 12+ months after diagnosis, or until they died. We calculated monthly mortality and hospitalization rates and hospitalization payments for all patients, and separately, for those who received chemotherapy (identified using MS-DRGs, HCPCS, revenue center, and ICD9 procedure codes).

Of 8,701 patients, 65% (5,641/8,701) died within 6 months after diagnosis; only 22% (1,941/8,701) survived at least 12 months. Monthly hospitalization rates were higher for patients who died within 6 months (.85/month), compared to those who survived (.35/month). Study patients had 19,738 hospitalizations; 5,757 included chemotherapy. Among patients treated with chemotherapy (3,071), 36% survived 12+ months (vs. 16% of untreated patients), but their initial hospitalizations (H) had higher payments, longer lengths-of-stay and higher ICU admission rates, compared to untreated patients (e.g., H1: Mean [SD]/Median: $38,695 [36,524]/$31,118; 19.3d [16.0]/15d; 31.6%; vs. $16,441 [15,954]/$12,109; 6.4d [6.6]/5d; 29.3%). Treated patients’ subsequent hospitalizations were shorter, with fewer ICU stays and lower payments (e.g., H4: N=1,234; $22,008 [23,761]/$12,562; 9.0d [9.5]/5d; 23.4%).

Hospitalizations for AML patients are frequent, especially in the 6 months following diagnosis. Payments for hospitalizations for patients treated with chemotherapy are higher than for untreated, but provide value in longer patient survival. Initiatives to extend chemotherapy to higher risk patients, coupled with programs to support outpatient chemotherapy for some patients, could potentially improve survival and quality-of-life.