Childhood cancer inpatient utilization: Patterns, costs, associated factors, and time trends from 2003 to 2009

Background: Childhood cancer treatment is complex, resource-intense, at high risk for complications and relies heavily upon inpatient hospital services. Inpatient costs for childhood cancer increased by 36% from 2000 until 2009 outstripping the 30% cost increase for non-cancer admissions over that same time. This project aimed to describe the patterns and trends of admissions for children with cancer by diagnosis and to determine the associations between variations in cost and socio-demographic, hospital, and geographic factors. ^ Methods: Using the 2003, 2006, and 2009 Kids Inpatient Databases, products of the Healthcare Costs and Utilization Project, I identified 331,307 admissions associated with a cancer diagnosis. These admissions were grouped by cancer diagnosis and reasons for admission. Admissions charges were converted to costs using the average hospital cost to charge ratio. Time trends in utilization were calculated using linear (continuous variable) or logistic (categorical variable) regressions. I fit a multi-level model clustered on the admitting hospital of the of cancer diagnosis, reasons for admission, socio-demographic and location of treatment on the log-transformed total admission cost. Clustering was accounted for with both clustered ordinary least squared and fixed effects models. ^ Results: The number of admissions per year did not change from 2003 until 2009 but the total annual national costs increased by 20.6%. That increase was not evenly distributed across diseases or admission types. ALL inpatient admissions accounted for the greatest national costs and greatest increases over the time studied. AML, the sixth most common cancer diagnosis, had the highest average costs per admission was the second most costly diagnosis nationally. Socio-demographic factors, especially age, race, and payer status influenced admission costs but were complicated by collinearity. Admissions in freestanding children\u27s hospitals were significantly more expensive on average than other types of hospitals. Admissions occurring in states along the west coast were also more expensive. ^ Conclusions: This study provides an overview of contemporary trends in treatment of childhood cancer. It highlights the complexity of this group of diseases and the needs to consider social factors and geography in future research. Future studies linking the differences identified with outcomes would be of value to further guide changes in clinical practice, healthcare systems or policies.