de Oliveira Claire, Bremner Karen E, Liu Ning, Greenberg Mark L, Nathan Paul C, McBride Mary L, Krahn Murray D
Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
Value Health. 2017 Mar;20(3):345-356. doi: 10.1016/j.jval.2016.10.010. Epub 2016 Dec 1.
Childhood and adolescent cancers are uncommon, but they have important economic and health impacts on patients, families, and health care systems. Few studies have measured the economic burden of care for childhood and adolescent cancers.
To estimate costs of cancer care in population-based cohorts of children and adolescents from the public payer perspective.
We identified patients with cancer, aged 91 days to 19 years, diagnosed from 1995 to 2009 using cancer registry data, and matched each to three noncancer controls. Using linked administrative health care records, we estimated total and net resource-specific costs (in 2012 Canadian dollars) during 90 days prediagnosis and 1 year postdiagnosis.
Children (≤14 years old) numbered 4,396: 36% had leukemia, 21% central nervous system tumors, 10% lymphoma, and 33% other cancers. Adolescents (15-19 years old) numbered 2,329: 28.9% had lymphoma. Bone and soft tissue sarcoma, germ cell tumor, and thyroid carcinoma each comprised 12% to 13%. Mean net prediagnosis costs were $5,810 and $1,127 and mean net postdiagnosis costs were $136,413 and $62,326 for children and adolescents, respectively; the highest were for leukemia ($157,764 for children and $172,034 for adolescents). In both cohorts, costs were much higher for patients who died within 1 year of diagnosis. Inpatient hospitalization represented 69% to 74% of postdiagnosis costs.
Treating children with cancer is costly, more costly than treating adolescents or adults. Substantial survival gains in children mean that treatment may still be very cost-effective. Comprehensive age-specific population-based cost estimates are essential to reliably assess the cost-effectiveness of cancer care for children and adolescents, and measure health system performance.
儿童和青少年癌症并不常见，但它们对患者、家庭和医疗保健系统有着重要的经济和健康影响。很少有研究衡量过儿童和青少年癌症的护理经济负担。
从公共支付者的角度估计以人群为基础的儿童和青少年队列中癌症护理的成本。
我们利用癌症登记数据确定了1995年至2009年期间诊断出的年龄在91天至19岁之间的癌症患者，并为每位患者匹配了三名非癌症对照。利用相关的行政医疗保健记录，我们估计了诊断前90天和诊断后1年期间的总资源成本和特定资源净成本（以2012年加拿大元计）。
儿童（≤14岁）有4396名：36%患有白血病，21%患有中枢神经系统肿瘤，10%患有淋巴瘤，33%患有其他癌症。青少年（15 - 19岁）有2329名：28.9%患有淋巴瘤。骨肉瘤、软组织肉瘤、生殖细胞瘤和甲状腺癌各占12%至13%。儿童和青少年诊断前的平均净成本分别为5810美元和1127美元，诊断后的平均净成本分别为136413美元和62326美元；白血病的成本最高（儿童为157764美元，青少年为172034美元）。在两个队列中，诊断后1年内死亡的患者成本要高得多。住院治疗占诊断后成本的69%至74%。
治疗儿童癌症成本高昂，比治疗青少年或成年人的成本更高。儿童存活率的大幅提高意味着治疗可能仍然具有很高的成本效益。基于年龄的全面人群成本估计对于可靠评估儿童和青少年癌症护理的成本效益以及衡量卫生系统绩效至关重要。
