加拿大安大略省新诊断儿童急性淋巴细胞白血病不同治疗方案相关的医疗保健利用和成本：基于人群的研究。
Health care utilisation and costs associated with different treatment protocols for newly diagnosed childhood acute lymphoblastic leukaemia: A population-based study in Ontario, Canada.
机构信息
Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada; Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A8, Canada; Cancer Research Program, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada; Institute for Health Policy, Evaluation and Management, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada.
Cancer Research Program, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada; Institute for Health Policy, Evaluation and Management, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3MG, Canada.
出版信息
Eur J Cancer. 2021 Jul;151:126-135. doi: 10.1016/j.ejca.2021.04.006. Epub 2021 May 9.
BACKGROUND
Although different treatment protocols for childhood acute lymphoblastic leukaemia (ALL) all achieve high cure rates, their health care utilisation and costs have not been rigorously compared.
METHODS
Disease, treatment, and outcome data were chart abstracted for all children with ALL in Ontario, Canada, diagnosed 2002-2012. Linkage to population-based databases identified health care utilisation. Utilisation-associated costs were determined through validated algorithms. Chemotherapy-associated costs were calculated separately. Health care utilisation and costs were compared between patients receiving Children's Oncology Group (COG) versus Dana-Farber Cancer Institute (DFCI)-based treatment.
FINDINGS
Of 802 patients, 146 (18.2%) were treated on DFCI-based protocols. COG patients experienced significantly higher rates of emergency department (ED) visits (adjusted rate ratio [aRR]: 1.3, 95% confidence interval [CI]: 1.1-1.5; p = 0·01), whereas outpatient visit rates were 60% higher among DFCI patients (aRR: 1.6, 95% CI: 1.5-1.7, p < 0.0001). In adjusted analyses, DFCI-associated cost intensity was 70% higher (aRR: 1.7, 95% CI: 1.5-1.9; p < 0.0001), mainly attributable to outpatient visit costs. Total chemotherapy costs were higher among COG-treated patients ($39,400 ± $1100 versus $33,400 ± $2800; p = 0.02). Among PEG-ASNase-treated patients, total chemotherapy costs were highest among DFCI patients (median $54,200 ± $7400; p = 0.003 versus COG patients).
INTERPRETATION
COG and DFCI treatments were associated with higher ED visit rates and higher outpatient visit rates, respectively. Overall utilisation-associated costs were increased in DFCI-treated patients. Administration of some intravenous chemotherapy at home and decreases in PEG-ASNase cost would decrease health care utilisation and costs for all patients and mitigate differences between COG and DFCI protocols.
FUNDING
C Research Network.
背景
尽管不同的儿童急性淋巴细胞白血病（ALL）治疗方案都能达到很高的治愈率，但它们的医疗保健利用率和成本尚未经过严格比较。
方法
对 2002 年至 2012 年在加拿大安大略省诊断出的所有 ALL 患儿进行了疾病、治疗和结局数据的图表摘录。与基于人群的数据库的链接确定了医疗保健的利用率。通过验证算法确定了与利用率相关的成本。单独计算了化疗相关成本。比较了接受儿童肿瘤学组（COG）与 Dana-Farber 癌症研究所（DFCI）治疗的患者之间的医疗保健利用率和成本。
结果
在 802 名患者中，有 146 名（18.2%）接受了基于 DFCI 的方案治疗。COG 患者急诊就诊率明显更高（调整后的率比[ARR]：1.3，95%置信区间[CI]：1.1-1.5；p=0.01），而 DFCI 患者的门诊就诊率高 60%（ARR：1.6，95%CI：1.5-1.7，p<0.0001）。在调整分析中，DFCI 相关的成本强度高出 70%（ARR：1.7，95%CI：1.5-1.9；p<0.0001），主要归因于门诊就诊费用。COG 治疗患者的总化疗费用较高（$39400±$1100 与 $33400±$2800；p=0.02）。在 PEG-ASNase 治疗的患者中，DFCI 患者的总化疗费用最高（中位数 $54200±$7400；p=0.003 与 COG 患者相比）。
解释
COG 和 DFCI 治疗分别与更高的急诊就诊率和更高的门诊就诊率相关。DFCI 治疗患者的整体利用率相关成本增加。在家中给予一些静脉化疗，并降低 PEG-ASNase 的成本，将减少所有患者的医疗保健利用率和成本，并减轻 COG 和 DFCI 方案之间的差异。
资助
C 研究网络。
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