A retrospective analysis of treatment‐related hospitalization costs of pediatric, adolescent, and young adult acute lymphoblastic leukemia

Abstract

This retrospective study examined the longitudinal hospital outcomes (costs adjusted for inflation, hospital days, and admissions) associated with the treatment of pediatric, adolescent, and young adult acute lymphoblastic leukemia (ALL). Patients between one and 26 years of age with newly diagnosed ALL, who were treated at Primary Children's Hospital (PCH) in Salt Lake City, Utah were included. Treatment and hospitalization data were retrieved from system‐wide cancer registry and enterprise data warehouse. PCH is a member of the Children's Oncology Group (COG) and patients were treated on, or according to, active COG protocols. Treatment‐related hospital costs of ALL were examined by computing the average annual growth rates (AAGR). Longitudinal regressions identified patient characteristics associated with costs. A total of 505 patients (46.9% female) were included. The majority of patients had B‐cell lineage ALL, 6.7% had T‐ALL, and the median age at diagnosis was 4 years. Per‐patient, first‐year ALL hospitalization costs at PCH rose from $24,197 in 1998 to $37,924 in 2012. The AAGRs were 6.1, 13.0, and 7.6% for total, pharmacy, and room and care costs, respectively. Average days (AAGR = 5.2%) and admissions (AAGR = 3.8%) also demonstrated an increasing trend. High‐risk patients had 47% higher costs per 6‐month period in the first 5 years from diagnosis than standard‐risk patients (P < 0.001). Similarly, relapsed ALL and stem cell transplantations were associated with significantly higher costs than nonrelapsed and no transplantations, respectively (P < 0.001). Increasing treatment‐related costs of ALL demonstrate an area for further investigation. Value‐based interventions such as identifying low‐risk fever and neutropenia patients and managing them in outpatient settings should be evaluated for reducing the hospital burden of ALL.

A cost analysis of individualized asparaginase treatment in pediatric acute lymphoblastic leukemia

“…Several pharmacoeconomic analyses of pediatric ALL treatment and asparaginase treatment have been performed . However, none of these include TDM.…”

Costs of cancer care in children and adolescents in Ontario, Canada

“…A recent systematic review identified 40 economic evaluations, but many were from a single institution or had a short time line . Other studies that measured overall childhood cancer costs are limited by small sample size or include only one type of cancer . Furthermore, the costs of follow‐up, complications, and relapse are required to estimate the total burden of childhood cancer.…”

A cost‐effectiveness analysis of Erwinia asparaginase therapy in children with acute lymphoblastic leukemia

“…Ideally, these costs would have been considered in the sensitivity analysis, but cost data from relapse patients were not available. Kaul et al report a threefold increase in costs when patients experience a relapse compared to no relapse, although actual costs of pediatric relapse therapy have not been described . Hence, switching to Erwinia asparaginase would save more future costs.…”