Paul C Nathan1,2,3, Karen E Bremner4, Ning Liu5, Sumit Gupta1,2,3, Mark L Greenberg1,3,6, Mary L McBride7,8, Murray D Krahn2,9,10,4,5,11, Claire de Oliveira2,5,12. 1. Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada. 2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 3. Department of Paediatrics, University of Toronto, Toronto, ON, Canada. 4. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. 5. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 6. Pediatric Oncology Group of Ontario, Toronto, ON, Canada. 7. British Columbia Cancer Agency, Vancouver, BC, Canada. 8. University of British Columbia, Vancouver, BC, Canada. 9. Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. 10. Department of Medicine, University of Toronto, Toronto, ON, Canada. 11. Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada. 12. Centre for Addiction and Mental Health, Toronto, ON, Canada.
Abstract
BACKGROUND: Adolescents with cancer can receive care in pediatric or adult institutions. Survival often differs by locus, but little is known about relative health care utilization and costs. We estimated these in a population-based cohort of adolescents. METHODS: All Ontario adolescents (15.0-17.9 years) diagnosed with cancer between 1995 and 2010 were identified from provincial cancer registries. We compared health care resource utilization (hospitalizations, emergency department visits, same-day surgeries, outpatient chemotherapy, radiation, diagnostic/laboratory tests, physician services, home care) and costs (2012 Canadian dollars) during four discrete care phases-prediagnosis (60 days), initial (360 days), continuing (variable), and terminal (360 days)-between adolescents treated in pediatric vs adult institutions, for the whole cohort and within seven diagnostic categories. All statistical tests were two-sided. RESULTS: Of 1356 eligible adolescents, 691 and 665 were treated in adult and pediatric institutions, respectively. Hospitalization rates were higher in pediatric institutions during prediagnosis (14.9% vs 6.9%, P < .001), initial (95.1% vs 73.3%, P < .001), and continuing phases (43.2% vs 34.4%, P = .002), but similar (96.1% vs 96.3%, P = .93) during the terminal phase. Average length of stay was higher at pediatric institutions within most diagnoses and phases. For all diagnoses, median initial phase costs were higher in pediatric than adult institutions (eg, leukemia: $153 926 vs $102 418 per 360 days, P < .001; lymphoma: $65 025 vs $19 846, P < .001, respectively). CONCLUSIONS: The costs of caring for adolescents with the same malignancy are considerably higher in pediatric than adult institutions during most phases. Resource utilization, particularly hospitalization, drives much of the cost difference, making these data applicable to other jurisdictions.
BACKGROUND: Adolescents with cancer can receive care in pediatric or adult institutions. Survival often differs by locus, but little is known about relative health care utilization and costs. We estimated these in a population-based cohort of adolescents. METHODS: All Ontario adolescents (15.0-17.9 years) diagnosed with cancer between 1995 and 2010 were identified from provincial cancer registries. We compared health care resource utilization (hospitalizations, emergency department visits, same-day surgeries, outpatient chemotherapy, radiation, diagnostic/laboratory tests, physician services, home care) and costs (2012 Canadian dollars) during four discrete care phases-prediagnosis (60 days), initial (360 days), continuing (variable), and terminal (360 days)-between adolescents treated in pediatric vs adult institutions, for the whole cohort and within seven diagnostic categories. All statistical tests were two-sided. RESULTS: Of 1356 eligible adolescents, 691 and 665 were treated in adult and pediatric institutions, respectively. Hospitalization rates were higher in pediatric institutions during prediagnosis (14.9% vs 6.9%, P < .001), initial (95.1% vs 73.3%, P < .001), and continuing phases (43.2% vs 34.4%, P = .002), but similar (96.1% vs 96.3%, P = .93) during the terminal phase. Average length of stay was higher at pediatric institutions within most diagnoses and phases. For all diagnoses, median initial phase costs were higher in pediatric than adult institutions (eg, leukemia: $153 926 vs $102 418 per 360 days, P < .001; lymphoma: $65 025 vs $19 846, P < .001, respectively). CONCLUSIONS: The costs of caring for adolescents with the same malignancy are considerably higher in pediatric than adult institutions during most phases. Resource utilization, particularly hospitalization, drives much of the cost difference, making these data applicable to other jurisdictions.
Authors: Anne E Mitchell; Deborah L Scarcella; Gemma L Rigutto; Vicky J Thursfield; Graham G Giles; Maree Sexton; David M Ashley Journal: Med J Aust Date: 2004-01-19 Impact factor: 7.738
Authors: S Smeland; A K Blystad; S O Kvaløy; I M Ikonomou; J Delabie; G Kvalheim; J Hammerstrøm; G F Lauritzsen; H Holte Journal: Ann Oncol Date: 2004-07 Impact factor: 32.976
Authors: Anne M Neilan; Frances Lu; Kelly A Gebo; Rebeca Diaz-Reyes; Mingshu Huang; Robert A Parker; Brad Karalius; Kunjal Patel; Cindy Voss; Andrea L Ciaranello; Allison L Agwu Journal: J Acquir Immune Defic Syndr Date: 2020-04-01 Impact factor: 3.771
Authors: Mary L McBride; Claire de Oliveira; Ross Duncan; Karen E Bremner; Ning Liu; Mark L Greenberg; Paul C Nathan; Paul C Rogers; Stuart J Peacock; Murray D Krahn Journal: Healthc Policy Date: 2020-02