Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.
University of Pennsylvania, Philadelphia, Pennsylvania.
Cancer. 2021 Jun 1;127(11):1901-1911. doi: 10.1002/cncr.33413. Epub 2021 Jan 19.
Individuals diagnosed with acute lymphoblastic leukemia (ALL) between the ages of 22 and 39 years experience worse outcomes than those diagnosed when they are 21 years old or younger. Treatment at National Cancer Institute-designated Comprehensive Cancer Centers (CCC) mitigates these disparities but may be associated with higher expenditures.
Using deidentified administrative claims data (OptumLabs Data Warehouse), the cancer-related expenditures were examined among patients with ALL diagnosed between 2001 and 2014. Multivariable generalized linear model with log-link modeled average monthly health-plan-paid (HPP) expenditures and amount owed by the patient (out-of-pocket [OOP]). Cost ratios were used to calculate excess expenditures (CCC vs non-CCC). Incidence rate ratios (IRRs) compared CCC and non-CCC monthly visit rates. Models adjusted for sociodemographics, comorbidities, adverse events, and months enrolled.
Clinical and sociodemographic characteristics were comparable between CCC (n = 160) and non-CCC (n = 139) patients. Higher monthly outpatient expenditures in CCC patients ($15,792 vs $6404; P < .001) were driven by outpatient hospital HPP expenditures. Monthly visit rates and per visit expenditures for nonchemotherapy visits (IRR = 1.6; P = .001; CCC = $8247, non-CCC = $1191) drove higher outpatient hospital expenditures among CCCs. Monthly OOP expenditures were higher at CCCs for outpatient care (P = .02). Inpatient HPP expenditures were significantly higher at CCCs ($25,918 vs $13,881; ꞵ = 0.9; P < .001) before accounting for adverse events but were no longer significant after adjusting for adverse events (ꞵ = 0.4; P = .1). Hospitalizations and length of stay were comparable.
Young adults with ALL at CCCs have higher expenditures, likely reflecting differences in facility structure, billing practices, and comprehensive patient care. It would be reasonable to consider CCCs comparable to the oncology care model and incentivize the framework to achieve superior outcomes and long-term cost savings.
Health care expenditures in young adults (aged 22-39 years) with acute lymphoblastic leukemia (ALL) are higher among patients at National Cancer Institute-designated Comprehensive Cancer Centers (CCC) than those at non-CCCs. The CCC/non-CCC differences are significant among outpatient expenditures, which are driven by higher rates of outpatient hospital visits and outpatient hospital expenditures per visit at CCCs. Higher expenditures and visit rates of outpatient hospital visits among CCCs may also reflect how facility structure and billing patterns influence spending or comprehensive care. Young adults at CCCs face higher inpatient HPP expenditures; these are driven by serious adverse events.
22 岁至 39 岁被诊断患有急性淋巴细胞白血病 (ALL) 的个体比 21 岁及以下被诊断患有 ALL 的个体预后更差。在国立癌症研究所指定的综合癌症中心 (CCC) 进行治疗可以减轻这些差异，但可能与更高的支出有关。
使用匿名行政索赔数据（OptumLabs Data Warehouse），对 2001 年至 2014 年间被诊断患有 ALL 的患者的癌症相关支出进行了研究。使用对数链接的多变量广义线性模型对平均每月健康计划支付 (HPP) 支出和患者自付额 (OOP) 进行建模。成本比用于计算超额支出（CCC 与非 CCC）。使用发病率比 (IRR) 比较 CCC 和非 CCC 的每月就诊率。模型调整了社会人口统计学、合并症、不良事件和入组月份。
CCC（n=160）和非 CCC（n=139）患者的临床和社会人口统计学特征相似。CCC 患者的门诊医疗 HPP 支出更高（每月 15792 美元与每月 6404 美元；P<0.001），这是由门诊医院 HPP 支出驱动的。非化疗就诊的每月就诊率和每次就诊费用（IRR=1.6；P=0.001；CCC=8247 美元，非 CCC=1191 美元）导致 CCC 中门诊医院支出更高。CCC 中门诊护理的每月 OOP 支出更高（P=0.02）。CCC 中住院 HPP 支出明显更高（每月 25918 美元与每月 13881 美元；ꞵ=0.9；P<0.001），但在调整不良事件后不再显著（ꞵ=0.4；P=0.1）。住院和住院时间相似。
在 CCC 接受治疗的年轻 ALL 患者的支出更高，这可能反映了设施结构、计费实践和综合患者护理方面的差异。将 CCC 视为肿瘤护理模式并激励其实现卓越的结果和长期成本节约是合理的。
22 岁至 39 岁的急性淋巴细胞白血病（ALL）青年患者的医疗保健支出在国立癌症研究所指定的综合癌症中心（CCC）的患者中高于非 CCC 的患者。CCC/非 CCC 之间的差异在门诊支出中很显著，这是由 CCC 更高的门诊医院就诊率和每次就诊的门诊医院支出驱动的。CCC 中更高的门诊医院就诊支出和就诊率可能也反映了设施结构和计费模式如何影响支出或综合护理。CCC 中的年轻成年人面临更高的住院 HPP 支出；这些是由严重的不良事件驱动的。
