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Nabukalu D, Gordon LG, Lowe J, Merollini KMD. Healthcare costs of cancer among children, adolescents, and young adults: A scoping review. Cancer Med 2024; 13:e6925. [PMID: 38214042 PMCID: PMC10905233 DOI: 10.1002/cam4.6925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To collate and critically review international evidence on the direct health system costs of children and adolescents and young adults (AYA) with cancer. METHODS We conducted searches in PubMed, MEDLINE, CINAHL, and Scopus. Articles were limited to studies involving people aged 0-39 years at cancer diagnosis and published from 2012 to 2022. Two reviewers screened the articles and evaluated the studies using the Consolidated Health Economic Evaluation Reporting Standards checklist. The reviewers synthesized the findings using a narrative approach and presented the costs in 2022 US dollars for comparability. RESULTS Overall, the mean healthcare costs for all cancers in the 5 years post diagnosis ranged from US$36,670 among children in Korea to US$127,946 among AYA in the USA. During the first year, the mean costs among children 0-14 years ranged from US$34,953 in Chile to over US$130,000 in Canada. These were higher than the costs for AYA, estimated at US$61,855 in Canada. At the end of life, the mean costs were estimated at over US$300,000 among children and US$235,265 among adolescents in Canada. Leukemia was the most expensive cancer type, estimated at US$50,133 in Chile, to US$152,533 among children in Canada. Overall, more than a third of the total cost is related to hospitalizations. All the included studies were of good quality. CONCLUSIONS Healthcare costs associated with cancer are substantial among children, and AYA. More research is needed on the cost of cancer in low- and middle-income countries and harmonization of costs across countries.
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Affiliation(s)
- Doreen Nabukalu
- School of HealthUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
- Population Health ProgramQIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Louisa G. Gordon
- Population Health ProgramQIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
- School of NursingQueensland University of TechnologyKelvin GroveQueenslandAustralia
- School of Public HealthThe University of QueenslandHerstonQueenslandAustralia
| | - John Lowe
- School of HealthUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
| | - Katharina M. D. Merollini
- School of HealthUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
- Sunshine Coast Health InstituteSunshine Coast University HospitalBirtinyaQueenslandAustralia
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Khondker A, Groff M, Nunes S, Sun C, Jawa N, Lee J, Cockovski V, Hejri-Rad Y, Chanchlani R, Fleming A, Garg A, Jeyakumar N, Kitchlu A, Lebel A, McArthur E, Mertens L, Nathan P, Parekh R, Patel S, Pole J, Ramphal R, Schechter T, Silva M, Silver S, Sung L, Wald R, Gibson P, Pearl R, Wheaton L, Wong P, Kim K, Zappitelli M. KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors: Description of Clinical Research Protocol of the KINDEST-CCS Study. Can J Kidney Health Dis 2022; 9:20543581221130156. [PMID: 36325265 PMCID: PMC9618744 DOI: 10.1177/20543581221130156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Approximately 30% of childhood cancer survivors (CCSs) will develop chronic kidney disease (CKD) or hypertension 15 to 20 years after treatment ends. The incidence of CKD and hypertension in the 5-year window after cancer therapy is unknown. Moreover, extent of monitoring of CCS with CKD and associated complications in current practice is underexplored. To inform the development of new and existing care guidelines for CCS, the epidemiology and monitoring of CKD and hypertension in the early period following cancer therapy warrants further investigation. Objective To describe the design and methods of the KIdney aNd blooD prESsure ouTcomes in Childhood Cancer Survivors study, which aims to evaluate the burden of late kidney and blood pressure outcomes in the first ~10 years after cancer therapy, the extent of appropriate screening and complications monitoring for CKD and hypertension, and whether patient, disease/treatment, or system factors are associated with these outcomes. Design Two distinct, but related studies; a prospective cohort study and a retrospective cohort study. Setting Five Ontario pediatric oncology centers. Patients The prospective study will involve 500 CCS at high risk for these late effects due to cancer therapy, and the retrospective study involves 5,000 CCS ≤ 18 years old treated for cancer between January 2008 and December 2020. Measurements Chronic kidney disease is defined as Estimated glomerular filtration rate <90 mL/min/1.73 m2 or albumin-to-creatinine ratio ≥ 3mg/mmol. Hypertension is defined by 2017 American Academy of Pediatrics guidelines. Methods Prospective study: we aim to investigate CKD and hypertension prevalence and the extent to which they persist at 3- and 5-year follow-up in CCS after cancer therapy. We will collect detailed biologic and clinical data, calculate CKD and hypertension prevalence, and progression at 3- and 5-years post-therapy. Retrospective study: we aim to investigate CKD and hypertension monitoring using administrative and health record data. We will also investigate the validity of CKD and hypertension administrative definitions in this population and the incidence of CKD and hypertension in the first ~10 years post-cancer therapy. We will investigate whether patient-, disease/treatment-, or system-specific factors modify these associations in both studies. Limitations Results from the prospective study may not be generalizable to non-high-risk CCS. The retrospective study is susceptible to surveillance bias. Conclusions Our team and knowledge translation plan is engaging patient partners, researchers, knowledge users, and policy group representatives. Our work will address international priorities to improve CCS health, provide the evidence of new disease burden and practice gaps to improve CCS guidelines, implement and test revised guidelines, plan trials to reduce CKD and hypertension, and improve long-term CCS health.
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Affiliation(s)
- Adree Khondker
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Michael Groff
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Sophia Nunes
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carolyn Sun
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Jawa
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jasmine Lee
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vedran Cockovski
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yasmine Hejri-Rad
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rahul Chanchlani
- Department of Pediatrics, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Adam Fleming
- Department of Pediatric Hematology/Oncology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Amit Garg
- Department of Medicine, London Health Sciences Centre Research Inc., London, ON, Canada
| | | | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Asaf Lebel
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Serina Patel
- Department of Pediatric Hematology/Oncology, Children’s Hospital of Western Ontario, London, Canada
| | - Jason Pole
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Raveena Ramphal
- Department of Pediatrics, Children’s Hospital of Eastern Ontario–Ottawa Children’s Treatment Centre, Canada
| | - Tal Schechter
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mariana Silva
- Department of Pediatrics, Kingston Health Sciences Centre, ON, Canada
| | - Samuel Silver
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ron Wald
- Unity Health Toronto, ON, Canada
| | - Paul Gibson
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Rachel Pearl
- William Osler Health System, Brampton, ON, Canada
| | - Laura Wheaton
- Department of Pediatrics, Kingston Health Sciences Centre, ON, Canada
| | - Peter Wong
- William Osler Health System, Brampton, ON, Canada
| | - Kirby Kim
- Patient Partner, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Zappitelli
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada,Michael Zappitelli, Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Room 11.9722, 11th Floor, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
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Widjaja E, Demoe L, Yossofzai O, Guttmann A, Tomlinson G, Rutka J, Snead OC, Sander B. Health Care System Costs Associated With Surgery and Medical Therapy for Children With Drug-Resistant Epilepsy in Ontario. Neurology 2022; 98:e1204-e1215. [PMID: 35169008 DOI: 10.1212/wnl.0000000000200026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/03/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Improvement in seizure control after epilepsy surgery could lead to lower health care resource use and costs, but it is uncertain whether this could offset the high costs related to surgery. This study aimed to evaluate phase-specific and cumulative long-term health care costs of surgery compared to medical therapy in children with drug-resistant epilepsy from the health care payer perspective. METHODS Children who were evaluated for epilepsy surgery and treated with surgery or medical therapy from 2003 to 2018 at the Hospital for Sick Children in Toronto were identified from chart review and linked to their health administrative databases in Ontario, Canada. Inverse probability of treatment weighting with stabilized weights was used to balance the baseline covariates between the 2 groups. Patients were assigned to presurgery, surgery, short-term (first 2 years), intermediate-term (2-5 years), and long-term (>5 years) postsurgery care phases on the basis of treatment trajectory. Phase-specific and cumulative long-term health care costs were evaluated. Costs were converted from Canadian to US dollars year 2018 value. RESULTS There were 372 surgical and 258 medical patients. Costs were higher in surgical than medical patients for presurgery (3 and 39 weeks), surgery, and short-term care phase, and the attributable costs of surgery per 7 patient-days were $1,602 (95% CI $1,438-$1,785), $172 (95% CI $147-$185), $19,819 (95% CI $18,822-$20,932), and $28 (95% CI $22-$32), respectively. Costs were lower in surgical patients for intermediate- and long-term care phase, and the attributable costs were -$72 (95% CI -$124 to -$35) and -$94 (95% CI -$129 to -$63), respectively. In surgical patients, costs were highest for surgery followed by presurgery care phase, with hospitalizations accounting for the highest cost component. In medical patients, costs increased gradually from presurgery to long-term care phase. Cumulative costs were higher for surgical than medical patients in the first 7 years after surgery, but from 8 years on, costs were lower for surgical patients. DISCUSSION This study demonstrated the long-term economic benefits of epilepsy surgery compared to medical therapy for the health care system with the use of real-world data, which would justify the high costs of surgery. The results will support future economic evaluation comparing minimally invasive treatment such as laser therapy to surgery.
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Affiliation(s)
- Elysa Widjaja
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada.
| | - Lindsay Demoe
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - Omar Yossofzai
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - Astrid Guttmann
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - George Tomlinson
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - James Rutka
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - O Carter Snead
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - Beate Sander
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
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Zhao J, Han X, Zheng Z, Nogueira L, Lu AD, Nathan PC, Yabroff KR. Racial/Ethnic Disparities in Childhood Cancer Survival in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:2010-2017. [PMID: 34593561 DOI: 10.1158/1055-9965.epi-21-0117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/17/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-white patients with childhood cancer have worse survival than Non-Hispanic (NH) White patients for many childhood cancers in the United States. We examined the contribution of socioeconomic status (SES) and health insurance on racial/ethnic disparities in childhood cancer survival. METHODS We used the National Cancer Database to identify NH White, NH Black, Hispanic, and children of other race/ethnicities (<18 years) diagnosed with cancer between 2004 and 2015. SES was measured by the area-level social deprivation index (SDI) at patient residence and categorized into tertiles. Health insurance coverage at diagnosis was categorized as private, Medicaid, and uninsured. Cox proportional hazard models were used to compare survival by race/ethnicity. We examined the contribution of health insurance and SES by sequentially adjusting for demographic and clinical characteristics (age group, sex, region, metropolitan statistical area, year of diagnosis, and number of conditions other than cancer), health insurance, and SDI. RESULTS Compared with NH Whites, NH Blacks and Hispanics had worse survival for all cancers combined, leukemias and lymphomas, brain tumors, and solid tumors (all P < 0.05). Survival differences were attenuated after adjusting for health insurance and SDI separately; and further attenuated after adjusting for insurance and SDI together. CONCLUSIONS Both SES and health insurance contributed to racial/ethnic disparities in childhood cancer survival. IMPACT Improving health insurance coverage and access to care for children, especially those with low SES, may mitigate racial/ethnic survival disparities.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Amy D Lu
- The University of Toronto, Toronto, Ontario, Canada
| | - Paul C Nathan
- The University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Division of Hematology/Oncology, Toronto, Ontario, Canada
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Gupta S, Alexander S, Pole JD, Sutradhar R, Crump M, Nagamuthu C, Baxter NN, Nathan PC. Superior outcomes with paediatric protocols in adolescents and young adults with aggressive B-cell non-Hodgkin lymphoma. Br J Haematol 2021; 196:743-752. [PMID: 34599525 DOI: 10.1111/bjh.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Abstract
Survival disparities by locus of care (LOC; paediatric versus adult) among adolescents and young adults (AYA) with acute lymphoblastic leukaemia (ALL) are well documented. Whether similar disparities exist among AYA with aggressive mature B-cell non-Hodgkin lymphoma (B-NHL) is unknown. We identified all Ontario, Canada AYA aged 15-21 years at diagnosis of B-NHL between 1992 and 2012. Demographic, disease, treatment and outcome data were chart abstracted. The impact of LOC on event-free (EFS) and overall survival (OS) were determined, adjusted for patient and disease covariates. Among 176 AYA with B-NHL, 62 (35·2%) received therapy at paediatric centres. The 5-year EFS and OS [± standard error (SE)] for the overall cohort were 72·2 [3·4]% and 76·1 [3·2]% respectively. Both EFS and OS were superior among paediatric centre AYA [EFS (± SE) 82·2 (4·9)% vs. 66·7 (4·4)%, P = 0·02; OS 85·5 (4·5)% vs. 71·1 (4·3)%, P = 0·03]. Adjusted for histology, stage and time period, adult centre AYA had inferior EFS [hazard ratio (HR) 2·4, 95% confidence interval (CI) 1·1-4·9, P = 0·02] and OS (HR 2·5, 95% CI 1·1-5·7, P = 0·03). Sensitivity analyses restricted to the latest time period, when most adult centre AYA received rituximab, demonstrated similar disparities. Similar to AYA with ALL, AYA with B-NHL may benefit from being treated with paediatric protocols. Studies prospectively validating these results are warranted.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jason D Pole
- Cancer Research Program, ICES, Toronto, ON, Canada.,Center for Health Services Research, University of Queensland, Brisbane, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Crump
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | | | - Nancy N Baxter
- Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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6
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Pethick J, Chen C, Charnock J, Bowden R, Tzala E. Inpatient admissions and outpatient appointments in the first year post cancer diagnosis: A population based study from England. Cancer Epidemiol 2021; 74:102003. [PMID: 34425383 DOI: 10.1016/j.canep.2021.102003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Time spent in hospital (length of stay) is an important component of patient experience and the financial cost of cancer care. This study documents the length of stay across English cancer diagnoses at a national level and reports on variation by patient demographics and tumour characteristics. METHODS Data on all diagnoses of malignant neoplasms from the English National Cancer Registration and Analysis Service for 252,202 patients first diagnosed in 2015 was linked with NHS Digital's Admitted Patient Care and Outpatient Hospital Episode Statistics datasets to quantify length of stay within one year following diagnosis. Length of stay was modelled using linear regression adjusted for sex, age, tumour type, stage, time spent alive during the study period, vital status at end of study period, region, deprivation and ethnicity. RESULTS Patients spend a mean of 25 days (median = 17 days; IQR = 8-34 days) in hospital in their first year. Tumour type, stage, age and vital status corrections had the strongest effects in the model adjusting for other independent variables. Younger patients tended towards longer stays. CONCLUSION Length of stay varies among patients by tumour type, age and stage. Estimating future health service demands should account for changes in incident tumour characteristics.
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Affiliation(s)
- Joanna Pethick
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK.
| | - Cong Chen
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Health Data Insight (HDI) Community Interest Company (CIC), CPC4, Capital Park, Fulbourn, Cambridge, CB21 5XE, UK
| | - James Charnock
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
| | - Rachel Bowden
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
| | - Evangelia Tzala
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
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7
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Widjaja E, Guttmann A, Tomlinson G, Snead OC, Sander B. Economic burden of epilepsy in children: A population-based matched cohort study in Canada. Epilepsia 2020; 62:152-162. [PMID: 33258123 DOI: 10.1111/epi.16775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The economic burden of childhood epilepsy to the health care system remains poorly understood. This study aimed to determine phase-specific and cumulative long-term health care costs in children with epilepsy (CWE) from the health care payer perspective. METHODS This cohort study utilized linked health administrative databases in Ontario, Canada. Incident childhood epilepsy cases were identified from January 1, 2003 to June 30, 2017. CWE were matched to children without epilepsy (CWOE) on age, sex, rurality, socioeconomic status, and comorbidities, and assigned prediagnosis, initial, ongoing, and final care phase based on clinical trajectory. Phase-specific, 1-year and 5-year cumulative health care costs, attributable costs of epilepsy, and distribution of costs across different ages were evaluated. RESULTS A total of 24 411 CWE were matched to CWOE. The costs were higher for prediagnosis and initial care than ongoing care in CWE. Hospitalization was the main cost component. The costs of prediagnosis, initial, and ongoing care were higher in CWE than CWOE, with the attributable costs at $490 (95% confidence interval [CI] = $352-$616), $1322 (95% CI = $1247-$1402), and $305 (95% CI = $276-$333) per 30 patient-days, respectively. Final care costs were lower in CWE than CWOE, with attributable costs at -$2515 (95% CI = -$6288 to $961) per 30 patient-days. One-year and 5-year cumulative costs were higher in CWE ($14 776 [95% CI = $13 994-$15 546] and $39 261 [95% CI = $37 132-$41 293], respectively) than CWOE ($6152 [95% CI = $5587-$6768] and $15 598 [95% CI = $14 291-$17 006], respectively). The total health care costs were highest in the first year of life in CWE for prediagnosis, initial, and ongoing care. SIGNIFICANCE Health care costs varied along the continuum of epilepsy care, and were mainly driven by hospitalization costs. The findings identified avenues for remediation, such as enhancing care around the time of epilepsy diagnosis and better care coordination for epilepsy and comorbidities, to reduce hospitalization costs and the economic burden of epilepsy care.
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Affiliation(s)
- Elysa Widjaja
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Astrid Guttmann
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada.,Leong Centre for Healthy Children, University of Toronto, ON, Canada
| | - George Tomlinson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
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8
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Neilan AM, Lu F, Gebo KA, Diaz-Reyes R, Huang M, Parker RA, Karalius B, Patel K, Voss C, Ciaranello AL, Agwu AL. Higher Acuity Resource Utilization With Older Age and Poorer HIV Control in Adolescents and Young Adults in the HIV Research Network. J Acquir Immune Defic Syndr 2020; 83:424-433. [PMID: 31904706 PMCID: PMC7055514 DOI: 10.1097/qai.0000000000002280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Adolescents and young adults (AYA) with HIV experience poorer health outcomes compared with adults. To improve care for AYA with HIV, information about patterns of costly health care resource utilization is needed. METHODS Among 13-30 year olds in the US HIV Research Network, we stratified outpatient visits, emergency department (ED) visits, and inpatient days/person-year (PY) by HIV acquisition model [perinatal (PHIVY) and nonperinatal (NPHIVY)], age (13-17, 18-23, and 24-30 years), CD4 strata (<200, 200-499, and ≥500 cells/µL), and viral load (VL) suppression (<, ≥400 copies/mL [c/mL]) combined with antiretroviral (ARV) use. RESULTS Among 4540 AYA (PHIVY: 15%; NPHIVY: 85%), mean follow-up was 2.8 years. Among PHIVY, most person-time (PT) was spent between ages 13 and 23 years (13-17 years: 43%; 18-23 years: 45%), CD4 ≥500/µL (61%), and VL <400 c/mL (69%). Among NPHIVY, most PT was spent between ages 24 and 30 years (56%), with CD4 ≥500/µL (54%), and with VL <400 c/mL (67%). PT spent while prescribed ARVs and with VL ≥400 c/mL was 29% (PHIVY) and 24% (NPHIVY). For PHIVY and NPHIVY, outpatient visit rates were higher at younger ages (13-17 years and 18-23 years), lower CD4 (<200 and 200-499/µL), and among those prescribed ARVs. Rates of ED visits and inpatient days were higher during PT spent at older ages (18-23 years and 24-30 years), lower CD4 (<200 and 200-499/µL), and VL ≥400 c/mL. Utilization was higher among PHIVY than NPHIVY (outpatient: 12.1 vs. 6.0/PY; ED: 0.4 vs. 0.3/PY; inpatient: 1.5 vs. 0.8/PY). CONCLUSIONS More ED visits and inpatient days were observed during time spent at older ages, lower CD4 count, and VL ≥400 c/mL. Interventions to improve virologic suppression and immune response may improve outcomes, and thus decrease costly resource utilization, for AYA with HIV.
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Affiliation(s)
- Anne M Neilan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Frances Lu
- The Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Kelly A Gebo
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Mingshu Huang
- The Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Robert A Parker
- Harvard Medical School, Boston, MA
- The Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Brad Karalius
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and
| | - Kunjal Patel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and
- Center for Biostatistics in AIDS Research, Boston, MA
| | - Cindy Voss
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrea L Ciaranello
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD
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9
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McBride ML, de Oliveira C, Duncan R, Bremner KE, Liu N, Greenberg ML, Nathan PC, Rogers PC, Peacock SJ, Krahn MD. Comparing Childhood Cancer Care Costs in Two Canadian Provinces. ACTA ACUST UNITED AC 2020; 15:76-88. [PMID: 32176612 PMCID: PMC7075448 DOI: 10.12927/hcpol.2020.26129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Cancer in children presents unique issues for diagnosis, treatment and survivorship care. Phase-specific comparative cost estimates are important for informing healthcare planning. Objectives: The aim of this paper is to compare direct medical costs of childhood cancer by phase of care in British Columbia (BC) and Ontario (ON). Methods: For cancer patients diagnosed at <15 years of age and propensity-score-matched non-cancer controls, we applied standard costing methodology using population-based healthcare administrative data to estimate and compare phase-based costs by province. Results: Phase-specific cancer-attributable costs were 2%–39% higher for ON than for BC. Leukemia pre-diagnosis costs and annual lymphoma continuing care costs were >50% higher in ON. Phase-specific in-patient hospital costs (the major cost category) represented 63%–82% of ON costs, versus 43%–73% of BC costs. Phase-specific diagnostic tests and procedures accounted for 1.0%–3.4% of ON costs and 2.8%–13.0% of BC costs. Conclusions: There are substantial cost differences between these two Canadian provinces, BC and ON, possibly identifying opportunities for healthcare planning improvement.
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Affiliation(s)
- Mary L McBride
- Emerita Scientist, Cancer Control Research, British Columbia Cancer, Vancouver, BC
| | - Claire de Oliveira
- Independent Scientist and Health Economist, Center for Addiction and Mental Health, Toronto, ON
| | - Ross Duncan
- Graduate Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Karen E Bremner
- Research Associate, Toronto General Hospital Research Institute, University Health Network, Toronto, ON
| | - Ning Liu
- Senior Research Analyst, Institute for Clinical Evaluative Sciences, Toronto, ON
| | - Mark L Greenberg
- Chair in Childhood Cancer Control and Professor of Paediatrics and Surgery, Pediatric Oncology Group of Ontario, Toronto, ON
| | - Paul C Nathan
- Staff Oncologist and Director, Aftercare Program, The Hospital for Sick Children, Toronto, ON
| | - Paul C Rogers
- Clinical Professor, Division of Hematology, Oncology & Bone Marrow Transplant, BC Children's Hospital, Vancouver, BC
| | - Stuart J Peacock
- Distinguished Scientist, Leslie Diamond Chair in Cancer Survivorship, Cancer Control Research, British Columbia Cancer, Vancouver, BC
| | - Murray D Krahn
- Senior Scientist and Director, THETA Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON
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10
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Parsons HM, Muffly L, Alvarez EM, Keegan THM. Does Treatment Setting Matter? Evaluating Resource Utilization for Adolescents Treated in Pediatric vs Adult Cancer Institutions. J Natl Cancer Inst 2019; 111:224-225. [PMID: 30053066 DOI: 10.1093/jnci/djy123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Helen M Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA
| | - Elysia M Alvarez
- Division of Hematology Oncology, Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | - Theresa H M Keegan
- Division of Hematology and Oncology, Center for Oncology Hematology Outcomes Research and Training , University of California Davis School of Medicine, Sacramento, CA
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