Cost minimization analysis of two treatment regimens for low-risk rhabdomyosarcoma in children: a report from the Children's Oncology Group.
BACKGROUND
Recent Children's Oncology Group trials for low-risk rhabdomyosarcoma attempted to reduce therapy while maintaining excellent outcomes. D9602 delivered 45 weeks of outpatient vincristine and dactinomycin (VA) for patients in Subgroup A. ARST0331 reduced the duration of therapy to 22 weeks but added four doses of cyclophosphamide to VA for patients in Subset 1. Failure-free survival was similar. We undertook a cost minimization comparison to help guide future decision-making.


METHODS
Addressing the costs of treatment from the healthcare perspective we modeled a simple decision-analytic model from aggregate clinical trial data. Medical care inputs and probabilities were estimated from trial reports and focused chart review. Costs of radiation, surgery and off-therapy surveillance were excluded. Unit costs were obtained from literature and national reimbursement and inpatient utilization databases and converted to 2012 US dollars. Model uncertainty was assessed with first-order sensitivity analysis.


RESULTS
Direct medical costs were $46,393 for D9602 and $43,261 for ARST0331 respectively, making ARST0331 the less costly strategy. Dactinomycin contributed the most to D9602 total costs but varied with age (42-69%). Chemotherapy administration costs accounted for the largest proportion of ARST0331 total costs (39-57%). ARST0331 incurred fewer costs than D9602 under most alternative distributive models and alternative clinical practice assumptions.


CONCLUSIONS
Cost analysis suggests that ARST0331 may incur fewer costs than D9602 from the healthcare system's perspective. Attention to the services driving the costs provides directions for future efficiency improvements. Future studies should prospectively consider the patient and family's perspective.
Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas; University of Texas School of Public Health, Division of Management, Policy and Community Health, Houston, Texas.
Heidi
H
Russell
J Michael
JM
Swint
Lincy
L
Lal
Jane
J
Meza
David
D
Walterhouse
Douglas S
DS
Hawkins
M Fatih
MF
Okcu
D000359:Aftercare / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000191:economics; D003198:Computer Simulation; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D003952:Diagnostic Imaging / Q000191:economics; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D007223:Infant; D009010:Monte Carlo Method; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000191:economics; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000191:economics* / Q000628:therapy; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000191:economics; D016896:Treatment Outcome; D014481:United States
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim
childhood cancer; cost analysis; rhabdomyosarcoma