Cost comparison by treatment arm and center-level variations in cost and inpatient days on the phase III high-risk B acute lymphoblastic leukemia trial AALL0232

Amanda M. Dinofia, Alix E. Seif, Meenakshi Devidas, Yimei Li, Matthew Hall, Yuan Shung V. Huang, Viviane Cahen, Stephen P. Hunger, Naomi J. Winick, William L. Carroll, Brian T. Fisher, Eric C. Larsen, Richard Aplenc

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The Children's Oncology Group (COG) develops and implements multi-institutional clinical trials with the primary goal of assessing the efficacy and safety profile of treatment regimens for various pediatric cancers. However, the monetary costs of treatment regimens are not measured. AALL0232 was a COG randomized phase III trial for children with acute lymphoblastic leukemia that found that dexamethasone (DEX) was a more effective glucocorticoid than prednisone (PRED) in patients younger than 10 years, but PRED was equally effective and less toxic in older patients. In addition, high-dose methotrexate (HD-MTX) led to better survival than escalating doses of methotrexate (C-MTX). Cost data from the Pediatric Health Information System database were merged with clinical data from the COG AALL0232 trial. Total and component costs were compared between treatment arms and across hospitals. Inpatient costs were higher in the HD-MTX and DEX arms when compared to the C-MTX and PRED arms at the end of therapy. There was no difference in cost between these arms at last follow-up. Considerable variation in total costs existed across centers to deliver the same therapy that was driven by differences in inpatient days and pharmacy costs. The more effective regimens were found to be more expensive during therapy but were ultimately cost-neutral in longer term follow-up. The variations in cost across centers suggest an opportunity to standardize resource utilization for patients receiving similar therapies, which could translate into reduced healthcare expenditures.

Original languageEnglish (US)
JournalCancer Medicine
DOIs
StateAccepted/In press - Jan 1 2017

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Inpatients
Costs and Cost Analysis
Prednisone
Methotrexate
Therapeutics
Dexamethasone
Pediatrics
Health Information Systems
Poisons
Health Expenditures
Health Care Costs
Glucocorticoids
Clinical Trials
Databases
Delivery of Health Care
Safety
Survival
Neoplasms

Keywords

  • Child
  • Clinical trial
  • Costs
  • Leukemia
  • Variation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Cost comparison by treatment arm and center-level variations in cost and inpatient days on the phase III high-risk B acute lymphoblastic leukemia trial AALL0232. / Dinofia, Amanda M.; Seif, Alix E.; Devidas, Meenakshi; Li, Yimei; Hall, Matthew; Huang, Yuan Shung V.; Cahen, Viviane; Hunger, Stephen P.; Winick, Naomi J.; Carroll, William L.; Fisher, Brian T.; Larsen, Eric C.; Aplenc, Richard.

In: Cancer Medicine, 01.01.2017.

Research output: Contribution to journalArticle

Dinofia, Amanda M. ; Seif, Alix E. ; Devidas, Meenakshi ; Li, Yimei ; Hall, Matthew ; Huang, Yuan Shung V. ; Cahen, Viviane ; Hunger, Stephen P. ; Winick, Naomi J. ; Carroll, William L. ; Fisher, Brian T. ; Larsen, Eric C. ; Aplenc, Richard. / Cost comparison by treatment arm and center-level variations in cost and inpatient days on the phase III high-risk B acute lymphoblastic leukemia trial AALL0232. In: Cancer Medicine. 2017.
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