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Duration of Hospitalization as a Measure of Cost on Children’s Cancer Group Acute Lymphoblastic Leukemia Studies

From the Department of Pediatric Hematology-Oncology, Childrens Hospital, Los Angeles, CA; Division of Hematology-Oncology, Children’s Hospitals and Clinics, Minneapolis, MN; Department of Pediatrics, Hematology-Oncology, University of Michigan, Ann Arbor, MI; Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA; Department of Pediatric Hematology-Oncology, University of Chicago, Chicago, IL; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s Cancer Group, Arcadia, CA; and Department of Preventive Medicine, University of Southern California, Los Angeles, CA.

Address reprint requests to Paul S. Gaynon, MD, The Children’s Cancer Group, Attention: Lucia Noll, PO Box 60012, Arcadia, CA 91066-6012.

PURPOSE: We used duration of hospitalization as a surrogate for cost and event-free survival as a measure of effectiveness to estimate the cost-effectiveness ratios of various treatment regimens on Children’s Cancer Group trials for acute lymphoblastic leukemia.

PATIENTS AND METHODS: The analyses included 4,986 children (2 to 21 years of age) with newly diagnosed acute lymphoblastic leukemia enrolled onto risk-adjusted protocols between 1988 and 1995. Analyses were based on a model of 100 patients. The marginal cost-effectiveness ratio (hospital days per additional patient surviving event-free) was the difference in total duration of hospitalization divided by the difference in number of event-free survivors at 5 years for two regimens. Relapse-adjusted marginal cost of frontline therapy was the difference in total duration of hospitalization for frontline therapy plus relapse therapy divided by the difference in number of event-free survivors at 5 years on the frontline therapy for two regimens.

RESULTS: One or two delayed intensification (DI) phases, augmented therapy, and dexamethasone all improved outcome. Marginal cost-effectiveness of these regimens compared with the control regimens was 133 days per patient for DI, 117 days per patient for double DI, and 41 days per patient for augmented therapy. Dexamethasone resulted in 17 fewer days per patient. Relapse-adjusted marginal costs were 68 days per patient for DI and 52 days for double DI. Augmented therapy and dexamethasone-based therapy resulted in 16 and 82 fewer hospital days, respectively. The estimated cost-effectiveness for treating any first relapse was 250 days per patient.

CONCLUSION: DI, double DI, augmented therapy, and dexamethasone-based therapy are cost-effective strategies compared with current treatment of first relapse.

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