Costs associated with adverse events from remission induction for children with Acute Lymphoblastic Leukemia (ALL)

Abstract

Background ALL is the most frequent hematological tumor in children, so during remission induction chemotherapy protocol (RICP) adverse events (AEs) may appear. The public program in Mexico in charge of financial support to oncologic children without social security delivered a fix amount for ALL chemotherapy, but additional money needed to treat any other unexpected condition should be taken from the budget of the oncologic healthcare providers. So the purpose of our study was to estimate and evaluate the direct medical costs associated to EAs during RICP in children with ALL. Methods This study was retrospective, longitudinal, and observational based on medical records review of patients in RICP. The CTCAE was used to identify and classify AEs according to a SOC category. We focused on extracting resources data that were consumed both for inpatients and outpatients AEs. A micro-costing approach was adopted which involve quantification of each healthcare resource consumed by the hospital multiplying them by unit cost. The probability distributions of data were evaluated to identify the appropriated statistical tests to be used for comparisons between groups that were performed with Wilcoxon rank sum test. Generalized linear models (GLM) were adjusted to evaluate the effects of patient characteristics on total cost. Results Forty patients accumulated 204 inpatient and 81 outpatient AEs during RICP. Comparison of total costs between groups showed an incremental cost of $7,460.23 likewise attributable to AEs. The total cost of a pediatric patient undergoing RICP without adverse events was $3,078.36 and the total cost of a patient with AEs exceeds it threefold. Conclusions The costs associated with AEs during RICP in Mexican children with ALL representing a high burden for the healthcare provider. Generalized linear models showed that variables such as sex, risk category and alive status are associated with the total costs of AEs. This is the first study aiming to analyze the effect of ALL-related AEs on health care costs in pediatric population, so our results may help not only to local decision making but also it may contribute to the research agenda in this field.

Hepatic Dysfunction during Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma and Its Effects on Subsequent Therapy and Outcome

“…4 Remission induction is a major block of chemotherapy, and several complications are known to occur during this phase—febrile neutropenia, sepsis, bleeding, anemia, gastrointestinal disturbances, hepatic dysfunction, pancreatitis, venous thrombosis, etc. 5 Hepatic dysfunction could be due to leukemic infiltrates in the liver, nonalcoholic steatohepatitis, sepsis, hepatotropic viral infections, therapy-related toxicity seen due to asparaginase, rarely hyperinflammatory syndromes like hemophagocytic lymphohistiocytosis (HLH), and indirect hyperbilirubinemia due to underlying genetic syndromes like Gilbert's syndrome. 6 Hepatic dysfunction can contribute to morbidity by adding on to the underlying disease, delaying chemotherapy, dose modifications of chemotherapeutic agents, and rarely can cause mortality due to fulminant hepatic failure.…”