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Comparative treatment costs of risk-stratified therapy for childhood acute lymphoblastic leukemia in India
Tushar Mungle1, Nandana Das1, Saikat Pal2
1Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India.
Insights
Risk-stratified therapy for pediatric acute lymphoblastic leukemia (ALL) in India is cost-effective. This approach reduces treatment costs for standard and intermediate-risk patients through fewer hospital admissions.
Area of Science:
- Pediatric Oncology
- Health Economics
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Treatment costs and cost-effectiveness of pediatric ALL therapies are crucial in resource-limited settings like India.
- Risk stratification tailors treatment intensity based on patient-specific factors.
Purpose of the Study:
- To evaluate the treatment cost and cost-effectiveness of a risk-stratified therapy approach for pediatric ALL in India.
- To analyze cost variations across different risk strata (Standard-Risk, Intermediate-Risk, High-Risk, and T-ALL).
Main Methods:
- Retrospective cohort study of 145 pediatric ALL patients treated at a tertiary care facility.
- Cost analysis included total treatment duration, outpatient (OP), and inpatient (IP) costs.
- Cost-effectiveness assessed using WHO-CHOICE guidelines and disability-adjusted life years (DALYs).
Main Results:
- Median treatment costs varied by risk group: SR ($3900), IR ($5500), HR ($7400), and T-ALL ($8700).
- Chemotherapy accounted for 25%-35% of total costs.
- Non-therapy admissions significantly increased costs and duration for HR and T-ALL patients (over 50% of IP costs).
Conclusions:
- Risk-stratified therapy for pediatric ALL is highly cost-effective in the Indian setting.
- This approach can significantly reduce treatment costs for Standard-Risk (SR) and Intermediate-Risk (IR) patients by decreasing inpatient admissions for both chemotherapy and non-chemotherapy reasons.
Background:
To evaluate the treatment cost and cost effectiveness of a risk-stratified therapy to treat pediatric acute lymphoblastic leukemia (ALL) in India.
Methods:
The cost of total treatment duration was calculated for a retrospective cohort of ALL children treated at a tertiary care facility. Children were risk stratified into standard (SR), intermediate (IR) and high (HR) for B-cell precursor ALL, and T-ALL. Cost of therapy was obtained from the hospital electronic billing systems and details of outpatient (OP) and inpatient (IP) from electronic medical records. Cost effectiveness was calculated in disability-adjusted life years.
Results:
One hundred and forty five patients, SR (50), IR (36), HR (39), and T-ALL (20) were analyzed. Median cost of the entire treatment for SR, IR, HR, and T-ALL was found to be $3900, $5500, $7400, and $8700, respectively, with chemotherapy contributing to 25%-35% of total cost. Out-patient costs were significantly lower for SR (p < 0.0001). OP costs were higher than in-patient costs for SR and IR, while in-patient costs were higher in T-ALL. Costs for non-therapy admissions were significantly higher in HR and T-ALL (p < 0.0001), representing over 50% of costs of in-patient therapy. HR and T-ALL also had longer durations of non-therapy admissions. Based on WHO-CHOICE guidelines, the risk-stratified approach was very cost effective for all categories of patients.
Conclusions:
Risk-stratified approach to treat childhood ALL is very cost-effective for all categories in our setting. The cost for SR and IR patients is significantly reduced through decreased IP admissions for both, chemotherapy and non-chemotherapy reasons.
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