Duration of hospitalization as a measure of cost on childrens cancer groupacute lymphoblastic leukemia studies

Purpose: We used duration of hospitalization as a surrogate for cost and ev ent-free survival as a measure of effectiveness to estimate the cost-effect iveness ratios of various treatment regimens on Children's Cancer Group tri als for acute lymphoblastic leukemia. Patients and Methods: The analyses included 4,986 children (2 to 21 years o f age) with newly diagnosed acute lymphoblastic leukemia enrolled onto risk -adjusted protocols between 1988 and 1995. Analyses were based on a model o f 100 patients. The marginal cost-effectiveness ratio (hospital days per ad ditional patient surviving event-free) was the difference in total duration of hospitalization divided by the difference in number of event-free survi vors at 5 years for two regimens. Relapse-adjusted marginal cost of frontli ne therapy was the difference in total duration of hospitalization for fron tline therapy plus relapse therapy divided by the difference in number of e vent-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 the se 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 augmen ted therapy. Dexamethasane resulted in 17 fewer days per patient. Relapse-a djusted marginal costs were 68 days per patient for DI and 52 days for doub le 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 thera py are cost-effective strategies compared with current treatment of first r elapse. (C) 2001 by American Society of Clinical Oncology.