Costs associated with adverse events from remission induction for children with Acute Lymphoblastic Leukemia (ALL)
Eréndira Mejía-Aranguré1,2,3, Alfonso Reyes-López4, Luis Enrique Juárez-Villegas5
1Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas Y de La Salud, Universidad Nacional Autónoma de México, Ciudad de México, México. erenmejia@hotmail.com.
Insights
Adverse events during pediatric acute lymphoblastic leukemia chemotherapy significantly increase healthcare costs, tripling the total expense for affected children. Understanding these costs is crucial for resource allocation in pediatric oncology.
Area of Science:
- Pediatric Hematology
- Oncology
- Health Economics
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
- Chemotherapy protocols for ALL can lead to adverse events (AEs).
- In Mexico, unexpected AEs strain healthcare budgets for uninsured children.
Purpose of the Study:
- To estimate and evaluate the direct medical costs of AEs during remission induction chemotherapy protocol (RICP) in pediatric ALL patients.
- To assess the economic impact of AEs on healthcare providers.
Main Methods:
- Retrospective, longitudinal, observational study using medical records.
- Identification and classification of AEs using CTCAE criteria.
- Micro-costing approach to quantify consumed healthcare resources and unit costs.
Main Results:
- Forty patients experienced 204 inpatient and 81 outpatient AEs during RICP.
- AEs resulted in an incremental cost of $7,460.23 per patient.
- Total costs for patients with AEs were threefold higher than for those without.
Conclusions:
- AEs during pediatric ALL RICP impose a substantial financial burden on healthcare providers in Mexico.
- Patient characteristics like sex, risk category, and survival status influence total AE costs.
- This study provides foundational data for local decision-making and future research on pediatric ALL AEs and healthcare costs.
Background:
ALL is the most frequent hematological tumor in children, so during remission induction chemotherapy protocol (RICP) adverse events (AEs) may appear. The public program in Mexico in charge of financial support to oncologic children without social security delivered a fix amount for ALL chemotherapy, but additional money needed to treat any other unexpected condition should be taken from the budget of the oncologic healthcare providers. So the purpose of our study was to estimate and evaluate the direct medical costs associated to EAs during RICP in children with ALL.
Methods:
This study was retrospective, longitudinal, and observational based on medical records review of patients in RICP. The CTCAE was used to identify and classify AEs according to a SOC category. We focused on extracting resources data that were consumed both for inpatients and outpatients AEs. A micro-costing approach was adopted which involve quantification of each healthcare resource consumed by the hospital multiplying them by unit cost. The probability distributions of data were evaluated to identify the appropriated statistical tests to be used for comparisons between groups that were performed with Wilcoxon rank sum test. Generalized linear models (GLM) were adjusted to evaluate the effects of patient characteristics on total cost.
Results:
Forty patients accumulated 204 inpatient and 81 outpatient AEs during RICP. Comparison of total costs between groups showed an incremental cost of $7,460.23 likewise attributable to AEs. The total cost of a pediatric patient undergoing RICP without adverse events was $3,078.36 and the total cost of a patient with AEs exceeds it threefold.
Conclusions:
The costs associated with AEs during RICP in Mexican children with ALL representing a high burden for the healthcare provider. Generalized linear models showed that variables such as sex, risk category and alive status are associated with the total costs of AEs. This is the first study aiming to analyze the effect of ALL-related AEs on health care costs in pediatric population, so our results may help not only to local decision making but also it may contribute to the research agenda in this field.
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