Acute myeloid leukaemia: the value of treatment is also measured in terms of the time gained

This is the concept of value-based healthcare, which focuses on the value generated for the patient in relation to the resources used.

From this perspective, time can be viewed through five dimensions: the care capacity freed up, when a reduction in hospital admissions and visits makes resources available for other patients; the patient’s time, saved from journeys, waiting times and procedures and potentially reclaimed for everyday life; caregiver time, often spent on unpaid caregiving, a situation that affects 12.3 million adults in Italia, nearly a third of whom spend more than twenty hours a week on such care (Istat, 2026); the time leading up to access to treatment, from diagnosis to the start of treatment and from the approval of a new treatment to its actual availability; finally, time spent in good health, expressed in years of life gained and in years lived without disability.

On this last point, a clarification is in order. The absolute value of a year of life in good health remains ineffable, whilst it is possible to state how much one is willing to pay for it: this is the ‘willingness to pay’ threshold used in economic evaluations, and estimates vary. In the UK, NICE makes this explicit and adjusts it: the reference threshold rose in April 2026 from 20,000–30,000 to 25,000–35,000 pounds per year of healthy life, with a weighting of up to 1.7 times for more serious conditions. In Italia, there is no stated threshold; the most frequently cited academic reference remains the range of 25,000–40,000 euros, whilst analyses in the field of oncology typically adopt higher values, up to 80,000 euros per healthy life year. The same unit of measurement can therefore represent very different figures depending on the context, and the choice of which one to adopt is just as important as the measure itself.

These perspectives show that the value of a treatment cannot be reduced solely to its clinical efficacy or its direct cost. The time gained by the patient, their family and the healthcare system represents a benefit that deserves to be identified, measured and taken into account in decision-making.

Tools for measuring the value of time in healthcare have been around for decades. The challenge lies in translating the results of these analyses into concrete decisions: negotiating the price of a treatment and allocating budgets are the two moments when such a measurement either makes a difference or remains merely on paper.

The recommendations of the Second Panel on Cost-Effectiveness in Health and Medicine – the group that updated the international standards for economic evaluations in healthcare in 2016 – highlight the need to complement the healthcare system’s perspective with a social one, whilst also taking into account the effects on patients and carers. In practice, however, these factors may remain secondary to traditional indicators.

Time is a limited resource for everyone: for healthcare professionals, who are called upon to meet growing demand; for patients, who have to balance their treatment with their daily lives; and for family members, who shoulder a significant part of the care burden.

A treatment that reduces the time required to manage the disease can bring benefits across all these areas. To highlight these benefits, they must be incorporated into the economic and organisational assessment of the innovation. Time, too, can help guide decisions on the allocation of resources and investment priorities.

Acute myeloid leukaemia (AML) is a concrete example of how time can affect the experience of treatment and quality of life. In Italia, the disease affects around 3.5 people per 100,000 inhabitants per year (AIRC – Cancer Statistics in Italy 2025) and predominantly affects elderly and frail patients, with an average age at diagnosis of around 70 years (AIRC – Cancer Statistics in Italia 2025). For these individuals, the treatment journey can represent a significant burden, compounded by the clinical complexity of the disease.

Hospital admissions, travel, waiting times, procedures and recovery times all have an impact on the daily lives of patients and their carers. In oncology, this phenomenon is described by the concept of ‘time toxicity’ – the time-related toxicity of care: the time patients must devote to treatments, appointments, hospital admissions, travel and activities related to managing their illness (Gupta, Eisenhauer and Booth, Journal of Clinical Oncology, 2022).

This time is not necessarily wasted: it may be essential to ensure the effectiveness and safety of care. However, it represents a significant commitment for the patient and their family. For this reason, where clinically possible, reducing this time can become a key objective in the design of care pathways. In the case of LMA, this means considering not only clinical outcomes but also the way in which care is delivered, the frequency of hospital visits, the length of hospital stays and the burden of care on family members.

Innovation in healthcare is not limited to the availability of new treatments. It also requires reflection on the organisation of care and on the ability of care models to meet people’s overall needs. Simplifying care pathways, reducing avoidable care activities and improving organisation can help to ease the burden of care, free up resources and give patients and carers more time, without compromising quality and safety. However, not all hours are equal, and not every reduction in the time spent on care automatically represents a benefit. Time must be assessed alongside clinical outcomes, the safety of treatments and individual needs.

The challenge lies in incorporating time as one of the dimensions through which to assess the value of care. The value of a treatment is also measured by its ability to improve quality of life, preserve independence and make the entire care pathway more sustainable. Giving time back to patients, families and the healthcare system means recognising a fundamental component of the quality and value of innovation: as long as it remains an implicit factor, we will continue to experience its effects without, however, making it a genuine lever for decision-making.

*Associate Professor of Practice in the Government, Health and Not-for-Profit division at SDA Bocconi School of Management