Real-World Cost of Pediatric Acute Lymphoblastic Leukemia Care among Commercially Insured Individuals in the United States: Effect of Era and Age at Diagnosis

Lucie M. Turcotte, Dave Watson, Lynn Tanner, Alex Hoover, Laura Gilchrist, Mike Finch, Yoav Messinger

Research output: Contribution to journalArticlepeer-review


PURPOSE:Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Five-year survival is approaching 90%. In efforts to further improve outcomes, it is critical to consider the cost of ALL care.MATERIALS AND METHODS:Commercial insurance data from OptumLabs Data Warehouse were used to identify patients with ALL, age 1-30 years, diagnosed in 1993-2017 in the United States, with 36 months of continuous insurance coverage. Patients treated with hematopoietic cell transplantation were excluded. Inpatient and outpatient utilization and cumulative reimbursements (inflation-adjusted to December 2020) were computed 8 and 36 months from diagnosis and stratified by age (1-9, 10-12, and ≥ 13 years) as proxies for National Cancer Institute risk groups. Regression models were constructed to assess associations with demographic and clinical characteristics.RESULTS:Among 927 patients (median age, 6 years; interquartile range, 3-12 years; 43% female), individuals age ≥ 10 years had 23-25 more inpatient days and 22 more outpatient encounters compared with younger patients. The 36-month median cost was $394,000 (USD) (interquartile range, $256,000-$695,000 [USD]), and 64% of the total cost was incurred during the initial 8 months. The 36-month cost was 1.5-fold higher for those age 10-12 years and 1.7-fold higher for those age ≥ 13 years compared with 1-9 years. The cost for those diagnosed in 2013-2017 was 70% higher compared with 1993-2002, and was not different on the basis of sex, race, or ethnicity.CONCLUSION:Older age was associated with higher utilization and cost, and the cost of treatment increased significantly over time. These data provide valuable benchmarks for future studies examining the cost-benefit of ALL therapy modifications.

Original languageEnglish (US)
Pages (from-to)E1750-E1761
JournalJCO Oncology Practice
Issue number11
StatePublished - Nov 1 2022

Bibliographical note

Funding Information:
Supported in part by the National Cancer Institute Grant No. K08CA234232 (L.M.T.); the Pine Tree Apple Classic Fund (L.G., Y.H.M.); and the Children's Cancer Research Fund (L.M.T.).

Publisher Copyright:
© American Society of Clinical Oncology.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


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