Getz Kelly D, Li Yimei, Alonzo Todd A, Hall Matthew, Gerbing Robert B, Sung Lillian, Huang Yuan-Shung, Arnold Staci, Seif Alix E, Miller Tamara P, Bagatell Rochelle, Fisher Brian T, Adamson Peter C, Gamis Alan, Keren Ron, Aplenc Richard
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
University of Southern California, Los Angeles, California.
Pediatr Blood Cancer. 2015 Oct;62(10):1775-81. doi: 10.1002/pbc.25569. Epub 2015 May 6.
A better understanding of drivers of treatment costs may help identify effective cost containment strategies and prioritize resources. We aimed to develop a method for estimating inpatient costs for pediatric patients with acute myeloid leukemia (AML) enrolled on NCI-funded Phase III trials, compare costs between AAML0531 treatment arms (standard chemotherapy ± gemtuzumab ozogamicin (GMTZ)), and evaluate primary drivers of costs for newly diagnosed pediatric AML.
Patients from the AAML0531 trial were matched on hospital, sex, and dates of birth and diagnosis to the Pediatric Health Information Systems (PHIS) database to obtain daily billing data. Inpatient treatment costs were calculated as adjusted charges multiplied by hospital-specific cost-to-charge ratios. Generalized linear models were used to compare costs between treatment arms and courses, and by patient characteristics.
Inpatient costs did not differ by randomized treatment arm. Costs varied by course with stem cell transplant being most expensive, followed by Intensification II (cytarabine/mitoxantrone) and Induction I (cytarabine/daunorubicin/etoposide). Room/board and pharmacy were the largest contributors to inpatient treatment cost, representing 74% of the total cost. Higher AML risk group (P = 0.0003) and older age (P < 0.0001) were associated with significantly higher daily inpatient cost.
Costs from external data sources can be successfully integrated into NCI-funded Phase III clinical trials. Inpatient treatment costs did not differ by GMTZ exposure but varied by chemotherapy course. Variation in cost by course was driven by differences in duration of hospitalization through room/board charges as well as increased clinical and pharmacy charges in specific courses.
更好地了解治疗成本的驱动因素可能有助于确定有效的成本控制策略并合理分配资源。我们旨在开发一种方法，用于估算参加美国国立癌症研究所（NCI）资助的III期试验的急性髓系白血病（AML）儿科患者的住院费用，比较AAML0531治疗组（标准化疗±吉妥珠单抗奥唑米星（GMTZ））之间的费用，并评估新诊断的儿科AML成本的主要驱动因素。
将AAML0531试验中的患者按医院、性别、出生日期和诊断日期与儿科健康信息系统（PHIS）数据库进行匹配，以获取每日计费数据。住院治疗费用通过调整后的费用乘以特定医院的成本与收费比率来计算。使用广义线性模型比较治疗组和疗程之间以及不同患者特征的费用。
随机治疗组的住院费用没有差异。费用因疗程而异，干细胞移植最昂贵，其次是强化II（阿糖胞苷/米托蒽醌）和诱导I（阿糖胞苷/柔红霉素/依托泊苷）。食宿和药房是住院治疗费用的最大贡献者，占总成本的74%。较高的AML风险组（P = 0.0003）和年龄较大（P < 0.0001）与每日住院费用显著较高相关。
外部数据源的成本可以成功整合到NCI资助的III期临床试验中。住院治疗费用不因GMTZ暴露而有所不同，但因化疗疗程而异。疗程费用的差异是由住院时间通过食宿费用的差异以及特定疗程中临床和药房费用的增加所驱动的。
