The Economic Burden of Illness in Pediatric Acute Lymphoblastic Leukemia
(ALL) Patients from a Commercial and Medicaid Insurance Perspective
Abstract
Background: Pediatric acute lymphoblastic leukemia (ALL) treatment
regimens are lengthy, and there is limited data on the systemic and
individual economic burden associated with treatment of ALL. Objective:
This study aims to examine healthcare resource utilization (HCRU) and
costs accrued during the first year of therapy among pediatric ALL
patients, and to compare costs among those who are Commercially and
Medicaid insured. Methods: Administrative claims data from 2011-16 were
analyzed utilizing IBM MarketScan. Newly-diagnosed ALL patients with at
least 12 months of enrollment were studied. Demographics and HCRU and
costs were stratified by insurance type. The mean (standard deviation
(SD) HCRU and reimbursed costs were measured during the first year
post-diagnosis. Multivariable generalized linear models were run for
total healthcare costs. Results: 730 (528 Commercial) patients with
median age of 6 years were studied. During the 12 months following
diagnosis, the mean(SD) inpatient admissions and ER visits for
Commercial and Medicaid patients was 6.2(3.7) vs. 6.0(4.6), p=0.6310 and
2.8(6.4) vs. 2.1(2.6),p=0.0380, respectively. Commercial patients
experienced more outpatient visits (77.2(28.1) versus 57.4(33.3),
p<0.0001) and less pharmacy claims (54.1(22.9) and
61.0(41.8),p<0.0001) versus Medicaid patients. Total
healthcare costs were $535,135.89($547,506.23) versus
$198,694.94($181,856.27),p<0.0001 for Commercial and
Medicaid patients, respectively. When adjusted for age and gender, total
healthcare costs in the year post-diagnosis for Commercial patients were
1.60 times the costs in patients with Medicaid. Conclusion: Pediatric
ALL patients have high HCRU and incur significant economic burden. The
total cost of care for Commercially insured patients is more than double
that of Medicaid insured patients.