Inpatient Costs for Children and Young Adults with Acute Lymphoblastic Leukemia Higher at Specialized Cancer Centers, but for a Good Reason?

Chase Doyle

March 2019, Vol 9, No 3 - Quality Care


For children and young adults diagnosed with acute lymphoblastic leukemia (ALL), receiving treatment at specialized cancer centers has been associated with improved outcomes versus nonspecialized centers, but this comes at an increased cost, according to data presented at ASH 2018.

The results of a retrospective analysis of a population-based cohort showed that for children and young adults in California, the costs of inpatient care for a full course of therapy for primary ALL was higher in patients receiving all their care at specialized cancer centers. Moreover, the inpatient costs and the number of inpatient days were higher among young adults than among the children.

Nevertheless, the researchers emphasized that these costs must be considered in the context of the differences in outcomes observed with the different types of cancer centers.

Increased Costs, Improved Outcomes

“We believe that the marginal increased cost should be considered in the context of better outcomes at specialized cancer centers,” said Theresa H. M. Keegan, PhD, MS, Associate Professor, Center for Oncology Hematology Outcomes Research and Training, University of California Davis School of Medicine, Sacramento.

“Children and young adults receiving all their care at specialized centers have shown better leukemia-specific and overall survival than those receiving part or none of their care at these facilities. However, continuing to examine the burden of hospitalizations among young patients with ALL is important,” Dr Keegan added.

In this study, 24% of children and 29% of young adults with ALL had better leukemia-specific survival when they received all their care at a specialized cancer center. Although both age-groups benefit from care at specialized centers, only a minority of children and young adults receive treatment at such institutions.

Dr Keegan and colleagues used the California Cancer Registry linked to the Office of Statewide Health Planning and Development hospitalization database to identify children (aged 0-18 years) and young adults (aged 19-39 years) with first primary ALL who received inpatient treatment between 1995 and 2014 and had ≥3 years of follow-up.

Patients were classified as receiving all, part, or none of the treatment at a specialized cancer center within 3 years of diagnosis. The researchers used total charges for each admission and hospital-level financial information to calculate the costs for each admission.

Cost Difference: Children and Young Adults

Data for 5167 patients with ALL were analyzed. Compared with 91% of children in the study who received care at a specialized cancer center, only 42% of young adults did. The associated median costs were >$150,000 higher in young adults than in children, and young adults stayed a median of 37 days longer than children in the hospital during the first 3 years after diagnosis.

Among children, the total mean costs were >$25,000 higher for those who received care at a specialized cancer center than patients who received care at other institutions. Similarly, the mean daily cost was $2840 in children receiving all their care at a specialized cancer center versus $2283 daily in children receiving only part or none of their care at these facilities.

Among young adults, the mean cost for patients receiving all their care at a specialized cancer center was nearly $34,000 higher than among those not receiving care at these facilities. This translated into a mean daily cost of $3730 for patients receiving all their care at specialized cancer centers versus $3224 for those receiving care in other facilities.

These differences persisted when the analysis excluded patients who had a stem-cell transplant, said Dr Keegan, who noted that the mean and median numbers of inpatient days were similar for those who did and did not receive all their care at a specialized cancer center.

Because inpatient costs do not reflect the total cost burden associated with cancer care, Dr Keegan suggested that future studies should consider how the location of care affects outpatient costs, emergency department visits, and out-of-pocket costs for these patients with cancer.