Comparison of in-patient costs for children treated on the AAML0531 clinical trial: A report from the Children's Oncology Group.
Comparison of in-patient costs for children treated on the AAML0531 clinical trial: A report from the Children's Oncology Group.
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DOI：
10.1002/pbc.25569
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发表时间：
2015-10
影响因子：
3.2
通讯作者：
Aplenc R
中科院分区：
文献类型：
--
作者：
Getz KD;Li Y;Alonzo TA;Hall M;Gerbing RB;Sung L;Huang YS;Arnold S;Seif AE;Miller TP;Bagatell R;Fisher BT;Adamson PC;Gamis A;Keren R;Aplenc R
更好地了解治疗成本的驱动因素可能有助于确定有效的成本控制战略并确定资源的优先顺序。我们的目标是开发一种方法来估算参加NCI资助的III期试验的急性髓细胞白血病(AML)儿童患者的住院费用，比较AAML0531治疗组(标准化疗+吉珠单抗奥佐米星(GMTZ))之间的费用，并评估新诊断的儿童AML费用的主要驱动因素。来自AAML0531试验的患者根据医院、性别、出生日期和诊断日期与儿科健康信息系统(PHIS)数据库进行匹配，以获得每日账单数据。住院治疗费用的计算方法是调整后的费用乘以医院特定的费用/费用比率。广义线性模型被用来比较治疗手段和疗程之间的成本，并根据患者的特征进行比较。随机治疗组的住院费用没有差异。费用因疗程而异，干细胞移植的费用最高，其次是强化治疗II(阿糖胞苷/米托蒽醌)和诱导治疗I(阿糖胞苷/柔红霉素/依托泊苷)。食宿和药房是住院治疗费用的最大贡献者，占总费用的74%。急性髓系白血病风险较高组(P=0.0003)和高龄组(P<；0.0001)与显著较高的每日住院费用相关。来自外部数据源的成本可以成功地整合到NCI资助的第三阶段临床试验中。住院治疗费用并不因接触GMTZ而异，但因化疗疗程不同而异。由于住宿费/伙食费的住院时间不同，以及特定课程的临床和药房费用增加，各课程的费用有所不同。儿科血癌
A better understanding of drivers of treatment costs may help identify effective cost containment strategies and prioritize resources. We aimed to develop a method for estimating inpatient costs for pediatric patients with acute myeloid leukemia (AML) enrolled on NCI-funded Phase III trials, compare costs between AAML0531 treatment arms (standard chemotherapy ± gemtuzumab ozogamicin (GMTZ)), and evaluate primary drivers of costs for newly diagnosed pediatric AML. Patients from the AAML0531 trial were matched on hospital, sex, and dates of birth and diagnosis to the Pediatric Health Information Systems (PHIS) database to obtain daily billing data. Inpatient treatment costs were calculated as adjusted charges multiplied by hospital-specific cost-to-charge ratios. Generalized linear models were used to compare costs between treatment arms and courses, and by patient characteristics. Inpatient costs did not differ by randomized treatment arm. Costs varied by course with stem cell transplant being most expensive, followed by Intensification II (cytarabine/mitoxantrone) and Induction I (cytarabine/daunorubicin/etoposide). Room/board and pharmacy were the largest contributors to inpatient treatment cost, representing 74% of the total cost. Higher AML risk group (P = 0.0003) and older age (P < 0.0001) were associated with significantly higher daily inpatient cost. Costs from external data sources can be successfully integrated into NCI-funded Phase III clinical trials. Inpatient treatment costs did not differ by GMTZ exposure but varied by chemotherapy course. Variation in cost by course was driven by differences in duration of hospitalization through room/board charges as well as increased clinical and pharmacy charges in specific courses. Pediatr Blood Cancer