Health care utilisation and costs associated with different treatment protocols for newly diagnosed childhood acute lymphoblastic leukaemia: A population-based study in Ontario, Canada

Sumit Gupta; Rinku Sutradhar; Qing Li; Uma Athale; Mylene Bassal; Vicky Breakey; Paul J Gibson; Serina Patel; Mariana Silva; Veda Zabih; Petros Pechlivanoglou; Jason D Pole; Nicole Mittmann

doi:10.1016/j.ejca.2021.04.006

Health care utilisation and costs associated with different treatment protocols for newly diagnosed childhood acute lymphoblastic leukaemia: A population-based study in Ontario, Canada

Eur J Cancer. 2021 Jul:151:126-135. doi: 10.1016/j.ejca.2021.04.006. Epub 2021 May 9.

Authors

Sumit Gupta¹, Rinku Sutradhar², Qing Li³, Uma Athale⁴, Mylene Bassal⁵, Vicky Breakey⁴, Paul J Gibson⁴, Serina Patel⁶, Mariana Silva⁷, Veda Zabih⁸, Petros Pechlivanoglou⁹, Jason D Pole¹⁰, Nicole Mittmann¹¹

Affiliations

¹ Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada; Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A8, Canada; Cancer Research Program, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada; Institute for Health Policy, Evaluation and Management, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada. Electronic address: Sumit.gupta@sickkids.ca.
² Cancer Research Program, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada; Institute for Health Policy, Evaluation and Management, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada.
³ Cancer Research Program, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
⁴ Division of Haematology/Oncology, McMaster Children's Hospital, 1200 Main St W, Hamilton, L8N 3Z5, Canada.
⁵ Division of Haematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, K1H 8L1, Canada.
⁶ Division of Haematology/Oncology, London Health Sciences Centre, 800 Commissioners Rd, London, N6A 5W9, Canada.
⁷ Department of Pediatrics, Kingston General Hospital, 76 Stuart St, Kingston, K7L 2V7, Canada.
⁸ Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada; Sickkids Research Institute, The Hospital for Sick Children, 86 Bay St, Toronto, M5G 0A4, Canada.
⁹ Institute for Health Policy, Evaluation and Management, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada; Sickkids Research Institute, The Hospital for Sick Children, 86 Bay St, Toronto, M5G 0A4, Canada.
¹⁰ Cancer Research Program, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada; Center for Health Services Research, University of Queensland, 34 Cornwall St, Woolloongabba QLD 4102, Australia; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada.
¹¹ Institute for Health Policy, Evaluation and Management, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.

PMID: 33979728
DOI: 10.1016/j.ejca.2021.04.006

Abstract

Background: Although different treatment protocols for childhood acute lymphoblastic leukaemia (ALL) all achieve high cure rates, their health care utilisation and costs have not been rigorously compared.

Methods: Disease, treatment, and outcome data were chart abstracted for all children with ALL in Ontario, Canada, diagnosed 2002-2012. Linkage to population-based databases identified health care utilisation. Utilisation-associated costs were determined through validated algorithms. Chemotherapy-associated costs were calculated separately. Health care utilisation and costs were compared between patients receiving Children's Oncology Group (COG) versus Dana-Farber Cancer Institute (DFCI)-based treatment.

Findings: Of 802 patients, 146 (18.2%) were treated on DFCI-based protocols. COG patients experienced significantly higher rates of emergency department (ED) visits (adjusted rate ratio [aRR]: 1.3, 95% confidence interval [CI]: 1.1-1.5; p = 0·01), whereas outpatient visit rates were 60% higher among DFCI patients (aRR: 1.6, 95% CI: 1.5-1.7, p < 0.0001). In adjusted analyses, DFCI-associated cost intensity was 70% higher (aRR: 1.7, 95% CI: 1.5-1.9; p < 0.0001), mainly attributable to outpatient visit costs. Total chemotherapy costs were higher among COG-treated patients ($39,400 ± $1100 versus $33,400 ± $2800; p = 0.02). Among PEG-ASNase-treated patients, total chemotherapy costs were highest among DFCI patients (median $54,200 ± $7400; p = 0.003 versus COG patients).

Interpretation: COG and DFCI treatments were associated with higher ED visit rates and higher outpatient visit rates, respectively. Overall utilisation-associated costs were increased in DFCI-treated patients. Administration of some intravenous chemotherapy at home and decreases in PEG-ASNase cost would decrease health care utilisation and costs for all patients and mitigate differences between COG and DFCI protocols.

Funding: C¹⁷ Research Network.

Keywords: Acute lymphoblastic leukaemia; Cost; Health care utilization; Health economics; Health services research; Paediatric; Population based.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Ambulatory Care / economics
Antineoplastic Combined Chemotherapy Protocols / adverse effects
Antineoplastic Combined Chemotherapy Protocols / economics*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Child
Child, Preschool
Clinical Protocols
Cost-Benefit Analysis
Drug Costs*
Emergency Service, Hospital / economics
Female
Health Expenditures
Health Services Research
Hospital Costs*
Humans
Infant
Male
Ontario
Outcome and Process Assessment, Health Care / economics*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / diagnosis
Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / economics*
Time Factors
Treatment Outcome