An Analysis of Hospital Costs for Childhood Cancer Care

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Owen Tan GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, Australia.

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Deborah J. Schofield GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, Australia.

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Rupendra Shrestha GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, Australia.

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Background: This study used a linked dataset consisting of all childhood cancers recorded over the course of 10 years in New South Wales (NSW), Australia, to evaluate the hospital and emergency department costs (from a payer perspective) and resources used by patients with childhood cancer. We also analyzed determinants responsible for high-frequency hospital admissions, hospital length of stay (LoS), and hospital costs. Methods: We analyzed linked data at the individual patient level for a retrospective cohort of 2,966 patients with cancer aged <18 years with a diagnosis date between 2001 and 2012 from the NSW Central Cancer Registry, Australia. We reported costs and use of hospitalization and emergency department presentation 1 year before the date of diagnosis, 1 year after diagnosis, and 2 to 5 years after diagnosis. We also examined the association between cancer types and hospital admission and hospital costs from the payer perspective. Patient characteristics associated with the frequency of hospital admissions, hospital LoS, and hospital costs were also determined using a generalized linear model. Results: Most hospital admission costs occurred in the first year after diagnosis, accounting for >70% of hospital costs within 5 years after diagnosis. The estimated median annual cost of hospitalization in the first year after diagnosis was A$88,964 (interquartile range [IQR], A$34,399–A$163,968) for patients diagnosed at age 0 to 14 years and A$23,384 (IQR, A$5,585–A$91,565) for those diagnosed at age 15 to 17 years. Higher frequency of hospital admissions, hospital LoS, and hospital costs were significantly associated with younger age at cancer diagnosis, cancer metastases, and living in remote/disadvantaged socioeconomic areas. Conclusions: Our study represents one of the first in Australia to include detailed hospitalization cost information for all childhood cancer cases. This study highlights the high hospital use by pediatric patients and the importance of early diagnosis. Our findings also demonstrate the health inequities experienced by patients from remote areas and the lowest socioeconomic areas.

Submitted March 26, 2020; final revision received December 23, 2020; accepted for publication December 23, 2020. Published online August 6, 2021.

Author contributions: Study concept and design: All authors. Statistical analysis: Tan. Manuscript writing – original draft: Tan. Manuscript writing – review and editing: All authors. Final manuscript approval: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Owen Tan, MComm, GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Level 3, 4ER Eastern Road, Macquarie Park, NSW 2113, Australia. Email: owen.tan@mq.edu.au

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  • 1.

    Merrill CT, Nagamine M, Hambrick MM. Pediatric hospital stays for cancer, 2005: Statistical Brief #37. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality; 2006.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Price RA, Stranges E, Elixhauser A. Pediatric cancer hospitalizations, 2009: Statistical Brief #132. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality; 2012.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    de Oliveira C, Bremner KE, Liu N, et al. Costs for childhood and adolescent cancer, 90 days prediagnosis and 1 year postdiagnosis: a population-based study in Ontario, Canada. Value Health 2017;20:345356.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Australian Institute of Health and Welfare. Health System Expenditure on Cancer and Other Neoplasms in Australia 2008–09. Accessed March 13, 2020. Available at: https://www.aihw.gov.au/reports/health-welfare-expenditure/health-system-expenditure-cancer-2008-09/contents/table-of-contents

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Deloitte Access Economics. The economic cost of cancer in adolescents and young adults: assessing the impact. Accessed March 13, 2020. Available at: https://www2.deloitte.com/au/en/pages/economics/articles/economics-cost-cancer-adolescents-young-adults.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Lansky SB, Black JL, Cairns NU. Childhood cancer medical costs. Cancer 1983;52:762766.

  • 7.

    Rahiala J, Riikonen P, Kekäläinen L, et al. Cost analysis of the treatment of acute childhood lymphocytic leukaemia according to Nordic protocols. Acta Paediatr 2000;89:482487.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    de Oliveira C, Bremner KE, Liu N, et al. Costs of cancer care in children and adolescents in Ontario, Canada. Pediatr Blood Cancer 2017;64:e26628.

  • 9.

    Judicial Commission of New South Wales. Equality Before the Law Bench Book — Section 6 — children and young people. Accessed March 13, 2020. Available at: https://www.judcom.nsw.gov.au/publications/benchbks/equality/section06.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    United Nations Human Rights Office of the High Commissioner. Convention on the Rights of the Child. Accessed October 7, 2020. Available at: https://www.ohchr.org/en/professionalinterest/pages/crc.aspx

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Cancer Institute NSW. NSW Cancer Registry. Accessed March 13, 2020. Available at: https://www.cancer.nsw.gov.au/data-research/data-held-by-cinsw/nsw-cancer-registry

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Centre for Health Record Linkage. How record linkage works. Accessed March 13, 2020. Available at: https://www.cherel.org.au/how-record-linkage-works

  • 13.

    Cancer Institute NSW. Submit cancer cases to the NSW Cancer Registry. Accessed March 13, 2020. Available at: https://www.cancer.nsw.gov.au/research-and-data/cancer-data-and-statistics/submit-cancer-cases-to-the-nsw-cancer-registry

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    IHPA. National hospital cost data collection, public hospitals cost report, round 20 (financial year 2015-16). Accessed March 13, 2020. Available at: https://www.ihpa.gov.au/publications/national-hospital-cost-data-collection-public-hospitals-cost-report-round-20-financial

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Australian Government Department of Health. Archived hospital casemix protocol annual reports. HCP annual report 2015 - 2016. Accessed March 13, 2020. Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-publications-HCPAnnualReportsArchived

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Australian Bureau of Statistics. Consumer Price Index, Australia. Accessed March 12, 2020. Available at: https://www.abs.gov.au/statistics/economy/price-indexes-and-inflation/consumer-price-index-australia/latest-release

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Australian Bureau of Statistics. The Australian Statistical Geography Standard (ASGS) Remoteness Structure. Accessed March 13, 2020. Available at: https://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Australian Bureau of Statistics. 1033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. Accessed March 13, 2020. Available at: https://www.abs.gov.au/ausstats/abs@.nsf/DetailsPage/2033.0.55.0012011?OpenDocument

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Elsworthy AM, Claessen SM, Graham B, et al. ICD-10-AM: The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian modification: alphabetical index of diseases, 8 ed. Wollongong, Australia: National Casemix & Classification Centre, Australian Health Services Research Institute; 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Percy C, Van Holten V, Muir G, et al. New International Classification of Diseases for Oncology (ICD-O, 2nd Edition) and the neoplasm chapter of the 10th Revision of the International Classification of Diseases (ICD-10) [abstract]. Lab Invest 1990;62:A113.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Goldsbury D, Weber M, Yap S, et al. Identifying incident colorectal and lung cancer cases in health service utilisation databases in Australia: a validation study. BMC Med Inform Decis Mak 2017;17:23.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Luo Q, Yu XQ, Smith DP, et al. Cancer-related hospitalisations and ‘unknown’ stage prostate cancer: a population-based record linkage study. BMJ Open 2017;7:e014259.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Australian Institute of Health and Welfare. Australian refined diagnosis-related groups (AR-DRG) data cubes. Accessed March 13, 2020. Available at: aihw.gov.au/reports/hospitals/ar-drg-data-cubes/contents/data-cubes

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Baade PD, Youlden DR, Valery PC, et al. Population-based survival estimates for childhood cancer in Australia during the period 1997-2006. Br J Cancer 2010;103:16631670.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    National Cancer Control Indicators. Relative survival by stage at diagnosis 2011–2016, a snapshot in time. Accessed March 13, 2020. Available at: https://ncci.canceraustralia.gov.au/features/relative-survival-stage-diagnosis-2011%E2%80%932016-snapshot-time

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Working Group. International rules for multiple primary cancers (ICD-0 third edition): working group report. Eur J Cancer Prev 2005;14:307308.

  • 27.

    Mitchell RJ, Curtis K, Foster K. A 10-year review of child injury hospitalisations, health outcomes and treatment costs in Australia. Inj Prev 2018;24:344350.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Australian Institute of Health and Welfare. Australian health expenditure—demographics and diseases. Hospital admitted patient expenditure 2004–05 to 2012–13. Accessed March 13, 2020. Available at: https://www.aihw.gov.au/getmedia/fcccbe83-7953-424d-a8e5-c3859723b5c3/aihw-hwe-069.pdf.aspx?inline=true

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Wilkes JJ, Hennessy S, Xiao R, et al. Volume-outcome relationships in pediatric acute lymphoblastic leukemia: association between hospital pediatric and pediatric oncology volume with mortality and intensive care resources during initial therapy. Clin Lymphoma Myeloma Leuk 2016;16:404410.e1.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Australian Institute of Health and Welfare. Rural & remote health. Accessed March 13, 2020. Available at: https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/summary

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Rosenman MB, Vik T, Hui SL, et al. Hospital resource utilization in childhood cancer. J Pediatr Hematol Oncol 2005;27:295300.

  • 32.

    Mahmoud D, Skikne BS, Kucmin-Bemelmans I, et al. Overall economic burden of total treatment costs in acute myeloid leukemia throughout the course of the disease [abstract]. Blood 2012;120:3614.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Sprehe MR, Johnson R. Using chargemaster data to understand childhood leukemia costs [abstract]. Blood 2016;128:5938.

  • 34.

    Gupta S, Howard SC, Hunger SP, et al.. Treating childhood cancer in low- and middle-income countries. In: Gelband H, Jha P, Sankaranarayanan R, et al., eds. Cancer: Disease Control Priorities, Vol. 3. 3rd ed. Washington, DC: International Bank for Reconstruction and Development/World Bank; 2015:121146.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    GBD 2017 Childhood Cancer Collaborators. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017. Lancet Oncol 2019;20:12111225.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Ahrensberg JM, Olesen F, Hansen RP, et al. Childhood cancer and factors related to prolonged diagnostic intervals: a Danish population-based study. Br J Cancer 2013;108:12801287.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Wise J. Genome sequencing of children promises a new era in oncology. BMJ 2019;364:l105.

  • 38.

    Tervonen HE, Aranda S, Roder D, et al. Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia. BMC Public Health 2017;17:691.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Marmot M. Social determinants of health inequalities. Lancet 2005;365:10991104.

  • 40.

    Wakerman J, Humphreys JS. “Better health in the bush”: why we urgently need a national rural and remote health strategy. Med J Aust 2019;210:202203.e1.

  • 41.

    Fisk M, Livingstone A, Pit SW. Telehealth in the context of COVID-19: changing perspectives in Australia, the United Kingdom, and the United States. J Med Internet Res 2020;22:e19264.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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