Real-World Cost of Pediatric Acute Lymphoblastic Leukemia Care Among Commercially Insured Individuals in the United States: Effect of Era and Age at Diagnosis

Abstract

Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Five-year survival is approaching 90%. In efforts to further improve outcomes, it is critical to consider the cost of ALL care.

Commercial insurance data from OptumLabs Data Warehouse were used to identify patients with ALL, age 1-30 years, diagnosed in 1993-2017 in the United States, with 36 months of continuous insurance coverage. Patients treated with hematopoietic cell transplantation were excluded. Inpatient and outpatient utilization and cumulative reimbursements (inflation-adjusted to December 2020) were computed 8 and 36 months from diagnosis and stratified by age (1-9, 10-12, and ≥ 13 years) as proxies for National Cancer Institute risk groups. Regression models were constructed to assess associations with demographic and clinical characteristics.

Among 927 patients (median age, 6 years; interquartile range, 3-12 years; 43% female), individuals age ≥ 10 years had 23-25 more inpatient days and 22 more outpatient encounters compared with younger patients. The 36-month median cost was $394,000 (USD) (interquartile range, $256,000-$695,000 [USD]), and 64% of the total cost was incurred during the initial 8 months. The 36-month cost was 1.5-fold higher for those age 10-12 years and 1.7-fold higher for those age ≥ 13 years compared with 1-9 years. The cost for those diagnosed in 2013-2017 was 70% higher compared with 1993-2002, and was not different on the basis of sex, race, or ethnicity.

Older age was associated with higher utilization and cost, and the cost of treatment increased significantly over time. These data provide valuable benchmarks for future studies examining the cost-benefit of ALL therapy modifications.

© 2022 by American Society of Clinical OncologyPRIOR PRESENTATION

Presented in part, as an oral abstract, at the 2021 American Society of Hematology Annual Meeting, Atlanta, GA, December 13, 2021.

SUPPORT

Supported in part by the National Cancer Institute Grant No. K08CA234232 (L.M.T.); the Pine Tree Apple Classic Fund (L.G., Y.H.M.); and the Children's Cancer Research Fund (L.M.T.).

Conception and design: Lucie M. Turcotte, Dave Watson, Alex Hoover, Laura Gilchrist, Mike Finch, Yoav H Messinger

Financial support: Lucie M. Turcotte, Laura Gilchrist, Yoav Messinger

Administrative support: Lucie M. Turcotte

Collection and assembly of data: Dave Watson, Mike Finch

Data analysis and interpretation: All authors

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Real-World Cost of Pediatric Acute Lymphoblastic Leukemia Care Among Commercially Insured Individuals in the United States: Effect of Era and Age at Diagnosis

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Dave Watson

Research Funding: Merck (Inst)

Lynn Tanner

Patents, Royalties, Other Intellectual Property: Patent pending for mobile health application Serial No. 17/380,559, which is titled Systems and Methods for Functional Testing and Rehabilitation (Inst)

Mike Finch

Stock and Other Ownership Interests: SynerFuse, Metselex, Bipspheres, UrinaryTechnologies, BioSynthesis

Patents, Royalties, Other Intellectual Property: Synerfuse, Metselex, UrinryTechnologies, Biospheres, BioSynthesis

No other potential conflicts of interest were reported.

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