title: Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology.
abstract: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States.
  
  
  
  From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000.
  
  
  
  Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P<.0001). With a >16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of "$[(anesthesia cost to payer during radiation therapy course/6) - (CCLS expense to payer/N)]" per child (N) treated with radiation therapy, where N equals the number of children aged 3 to 12 years treated in 1 year. This formula assumes that the payer subsidizes the cost for the employment of a CCLS, although our institution absorbed this expense for this data cohort. The predicted annualized health care system cost savings from reducing the frequency of anesthesia with radiation therapy when treating 100 children aged 3 to 12 years per year could exceed $775,000.
  
  
  
  These data suggest that a CCLS significantly reduces the frequency of daily anesthesia for children treated with radiation therapy. Health care system payers may achieve significant cost savings by financially supporting the employment of a CCLS in high-volume pediatric radiation therapy centers.
authors.affiliation: Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Scott
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Todd
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Heather
authors.initials: H
authors.lastname: Oakley
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bradley
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Ronny L
authors.initials: RL
authors.lastname: Rotondo
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Stuart
authors.initials: S
authors.lastname: Klein
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Mendenhall
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida. Electronic address: dindelicato@floridaproton.org.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Indelicato
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D017046:Cost Savings / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000532:radiotherapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010372:Pediatrics / Q000191:economics; D015995:Prevalence; D018787:Radiation Oncology / Q000191:economics; D011878:Radiotherapy / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014600:Utilization Review / Q000191:economics