During remission induction (RI) treatment, adverse events (AEs) may require hospital treatment, causing partial or total suspension of the treatment protocol depending on their severity which delays the end of RI. We will follow up patients with AEs initiated in IR assuming that they may require several weeks of treatment before hospital discharge, which may represent a considerable cost for the hospital institution.
To estimate the incremental cost of the RI treatment protocol by the presence of AEs in children with ALL.
Children with a recent diagnosis of ALL, who are undergoing RI treatment. The AE experienced during remission were classified according to System Organ Class (SOC). With data available from the clinical records, we quantified and compared the direct medical costs generated between a group of patients who presented AE and another group that did not. Generalized linear models were developed to identify cost variations according to the frequency of events, which were associated with characteristics of the patient, such as sex, risk category and alive status.
297 AEs were identified in 86.8% of the patients, 68.7% of the events were treated in hospital. The total incremental cost to treat a patient who has adverse events during induction exceeds $7,000 and for each additional adverse event the total cost increase $527 dollars.
The cost of a pediatric patient undergoing RI without adverse events is $3,078.36. The average incremental cost to treat a patient with AEs exceeds twice the cost of a patient without events and the frequency of inpatient AEs in RI exceeds that of outpatient by three to one. Generalized linear models show that variables such as sex, risk category and alive status are associated with the presence, frequency and cost of AE. This is the first study aiming to analyze the effect of ALL-related AEs on health care costs in pediatric population, so our results may help not only to local decision making but also it may contribute to the research agenda in this field.