Recent research has indicated that ALL is the most common pediatric malignancy with 5-year survival approaching 90%.

Findings in a real-world analysis recently published in JCO Oncology Practice indicated that the costs of care for ALL is higher for patients diagnosed after age 9 years. In this study, researchers examined commercial insurance data from OptumLabs Data Warehouse in 927 patients with ALL diagnosed from 1993 to 2017. The average age at baseline was 6 years (range, 1-30), and 43% of patients were female. All of the study patients had 36 months of continuous insurance coverage, and none had undergone hematopoietic cell transplant.

Among the 927 patients, individuals aged 10 years and older had 23 to 25 more inpatient days and 22 more outpatient encounters compared with younger patients.

The results revealed that 36-month average inflation-adjusted cost of care was $394,000 in this cohort, and more than 60% of costs were incurred during the first 8 months of cancer treatment. When compared with patients aged 1 to 9 years, the 36-month cost was 1.5-fold higher for patients who were aged 10 to 12 years and 1.7-fold higher for patients who were aged 13 years or older.

The average total cost of care at 36 months was $695,000 for patients aged 13 years and older, $515,000 for patients aged 10 to 12 years, and $338,000 for patients aged 1 to 9 years. Average outpatient costs at 36 months were $187,000 for the cohort overall, $171,000 for patients aged 1 to 9 years, $221,000 for those aged 10 to 12 years, and $274,000 for those aged 13 years and older.

Average inpatient costs at 36 months were $180,000 for the cohort overall, $148,000 for patients aged 1 to 9 years, $278,000 for those aged 10 to 12 years, and $310,000 for those aged 13 years and older. When compared with patients aged 1 to 9 years, patients aged 10 to 12 years had 23.5 more inpatient days at 36 months, and patients who were aged 13 years or older had 25.2 more inpatient days at that time point. Additionally, the average number of inpatient days for the entire cohort was 39 days, and most hospitalizations occurred within the first 8 months of treatment (average, 30 days).

The researchers found that the cost of care was 50% to 70% greater among patients aged 10 to 30 years at diagnosis, compared with patients who were aged younger than 10 years. There were no differences on the basis of gender, race, or ethnicity.

The authors concluded that older age was correlated with greater utilization and cost, and the cost of treatment grew significantly over time. They also noted that the data provides useful benchmarks for future studies evaluating the cost-benefit of ALL therapy modifications.

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