title: 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.
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Sapna
authors.initials: S
authors.lastname: Kaul
authors.affiliation: Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Ernest Kent
authors.initials: EK
authors.lastname: Korgenski
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Jian
authors.initials: J
authors.lastname: Ying
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Christi F
authors.initials: CF
authors.lastname: Ng
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Rochelle R
authors.initials: RR
authors.lastname: Smits-Seemann
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Seth
authors.initials: S
authors.lastname: Andrews
authors.affiliation: University of Utah, Salt Lake City, Utah.|Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Raetz
authors.affiliation: University of Utah, Salt Lake City, Utah.|Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Mark
authors.initials: M
authors.lastname: Fluchel
authors.affiliation: University of Utah, Salt Lake City, Utah.|Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Richard
authors.initials: R
authors.lastname: Lemons
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acute lymphoblastic leukemia; hospital costs; pediatric/adolescent/young adult