title: Statewide Longitudinal Hospital Use and Charges for Pediatric and Adolescent Patients With Cancer.
abstract: OBJECTIVE
  We investigated longitudinal hospitalization outcomes (total charges, hospital days and admissions) among pediatric and adolescent patients with cancer compared with individuals from the general population without cancer using a novel and efficient three-step regression procedure.
  
  
  METHODS
  The statewide Utah Population Database, with linkages to the Utah Cancer Registry, was used to identify 1,651 patients who were diagnosed with cancer from 1996 to 2009 at ages 0 to 21 years. A comparison group of 4,953 same-sex and -age individuals was generated from birth certificates. Claims-based hospitalization data from 1996 to 2012 were retrieved from the Utah Department of Health. Using the regression method, we estimated survival (differences due to survival) and intensity (differences due to resource accumulation) effects of the cancer diagnosis on hospitalization outcomes within 10 years after diagnosis.
  
  
  RESULTS
  At 10 years after diagnosis, on average, patients with cancer incurred $51,723 (95% CI, $48,100 to $58,284) more in charges, spent 30 additional days (95% CI, 27.7 to 36.1 days) in the hospital, and had 5.7 (95% CI, 5.4 to 6.4) more admissions than the comparison group. Our analyses showed that the highest hospitalization burden occurred during the first 4 years of diagnosis. Patients with leukemia incurred the greatest hospitalization burden throughout the 10 years from diagnosis. Intensity effects explained the majority of differences in hospital outcomes.
  
  
  CONCLUSIONS
  Our results suggest that children and adolescents who were diagnosed with cancer in 2014 in the United States will incur over $800 million more in hospital charges than individuals without cancer by 2024. Interventions to reduce this burden should be explored in conjunction with improving health and survival outcomes.
authors.affiliation: University of Utah; and Utah Department of Health, Salt Lake City, UT sapna.kaul@hci.utah.edu.
authors.forename: Sapna
authors.initials: S
authors.lastname: Kaul
authors.affiliation: University of Utah; and Utah Department of Health, Salt Lake City, UT.
authors.forename: Bree
authors.initials: B
authors.lastname: Barbeau
authors.affiliation: University of Utah; and Utah Department of Health, Salt Lake City, UT.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wright
authors.affiliation: University of Utah; and Utah Department of Health, Salt Lake City, UT.
authors.forename: Mark
authors.initials: M
authors.lastname: Fluchel
authors.affiliation: University of Utah; and Utah Department of Health, Salt Lake City, UT.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
authors.affiliation: University of Utah; and Utah Department of Health, Salt Lake City, UT.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D007938:Leukemia / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000191:economics*; D010343:Patient Admission / Q000706:statistics & numerical data*; D014589:Utah; D055815:Young Adult