Study On The Overall Medical Costs Of Childhood Acute Lymphoblastic Leukemia And The Effectiveness In A Shanghai Children’s Hospital

Research Purpose:Childhood leukemia is one of the most life-threatening cancers that endangers children’s health and brings heavy burden to children and their families.The purpose of this study is to calculate the complete treatment costs of childhood Acute Lymphoblastic Leukemia（ALL）patients（up to 18 years of age）who were first diagnosed in a children’s hospital in Shanghai from May 1^st,2005 to December31^st,2015.The study also tried to analyze the influence factors of the medical cost and the effectiveness of the treatment costs so as to provide the government with evidence-based data to improve the healthcare support system and medical insurance for children with leukemia and reduce the economic burden for the family.Methods:（1）Objects:Children with newly diagnosed ALL in a Shanghai children’s tertiary hospital from May 1^st,2005 to December 31^st,2015 were enrolled.（2）Content:To study the overall medical costs of childhood ALL and to analyze the influence factors of the costs,effectiveness of the protocol. （3）SPSS 24.0 was used for data description and statistical analysis.All the costs were discounted according to the country’s CPI.Using non-parametric test for the costs statistics as the costs do not comply with normal distribution,multiple linear regression to find the influencing factors of the overall costs,Kaplan-Meier survival analysis to analyze the survival rate of the patients, grey correlation degree（GRA）method to analyze the correlation degree of each costs items to the total costs.Result:The average overall treatment of a child with ALL of low risk,intermediate risk and high risk children came to RMB13154.13,RMB209763.78 and RMB356811.14respectively.The risk was positively correlated with the overall costs（P<0.001）.Besides,relapsed patients,boys,younger than 1 year-old infants have higher overall medical costs（P<0.05）.GRA indicates that the drug costs have the greatest impact on the total costs.Outpatient costs accounted for 43.8%while in-hospital costs were56.20%.The overall survival（OS）for low risk,intermediate risk and high risk were86.83%,71.88%and 41.51%respectively.The OS of 2009 protocol was higher than that of 2005 protocol.Conclusion:As most of of the ALL children are long-term survivors,the relatively high complete treatment costs must be regarded as a good investment.However,children with ALL have relatively high medical costs,especially those at high risk have the highest cost of treatment but the worst outcome.The survival rate of ALL in China is still lower than some well-developed countries like Europe and America.It is suggested that the government should continue to improve the health supportive system and medical insurance of children with leukemia,implement the disease registration system,and provide policy support for new drug and technology research and development in China.