In a study reported in JCO Oncology Practice, Lucie M. Turcotte, MD, MPH, and colleagues found that real-world costs for care for commercially insured U.S. pediatric patients with acute lymphoblastic leukemia (ALL) were higher in those diagnosed at age 10 or older and have increased substantially overall over time.

Lucie M. Turcotte, MD, MPH

Study Details

The study used commercial insurance data from OptumLabs Data Warehouse to identify patients with ALL diagnosed between 1993 and 2017 at age 1 to 30 years with 36 months of continuous commercial insurance coverage. Patients treated with hematopoietic cell transplantation were excluded from the analysis. Patients were stratified by age 1 to 9, 10 to 12, and ≥ 13 as proxies for National Cancer Institute risk groups. Analysis of health-care utilization and costs was performed over 36 months, encompassing the period from diagnosis through primary treatment. Costs were adjusted for inflation to December 2020 U.S. dollars.

Key Findings

Among 927 patients included in the analysis, median age was 6 years (interquartile range [IQR]  = 3–12 years). A total of 643 were aged 1 to 9 years, 79 were aged 10 to 12 years, and 205 were aged ≥ 13 years. Overall, 9.5% of patients were diagnosed between 1993 and 2002, and 67% were diagnosed between 2007 and 2017.

At 36 months, patients aged ≥ 10 years had a median of 52 (age 10–12 years) and 56 (age ≥ 13 years) inpatient days compared with 33 for those aged 1 to 9 years, yielding an excess of 23 to 25 inpatient days for the older patients. The median number of outpatient encounters was 193 among patients aged 10 to 12 and 206 among those aged ≥ 13, compared with 179 among those between the ages of 1 and 9, yielding an excess of 14 to 27 days among older patients.

Overall, the 36-month median total cost was $394,000 (IQR = $256,000–$695,000), with 64% of the total cost incurred during the initial 8 months of therapy. Median cost was $338,000 among patients aged 1 to 9 years (64% during the initial 8 months), $515,000 among those aged 10 to 12 years (70.8% during the initial 8 months), and $695,000 among those aged ≥ 13 years (67.6% during the initial 8 months). Total costs were 1.5-fold and 1.7-fold higher among patients aged 10 to 12 and ≥ 13 years, respectively, vs those aged 1 to 9 years.

The total median cost for patients diagnosed from 2013 to 2017 was 70% higher compared with those diagnosed from 1993 to 2002—even after adjustment for inflation. No significant differences were observed for sex, race, or ethnicity in total costs.

The investigators concluded: “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.”

Dr. Turcotte, MD, of the Division of Pediatric Hematology/Oncology, University of Minnesota Medical School, Minneapolis, is the corresponding author forofthe JCO Oncology Practice article.

Disclosure: The study was supported by the National Cancer Institute, Pine Tree Apple Classic Fund, and Children’s Cancer Research Fund. For full disclosures of the study authors, visit ascopubs.org.