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      The Health Care Utilization and Medical Costs in Long-Term Follow-Up of Children Diagnosed With Leukemia, Solid Tumor, or Brain Tumor: Population-Based Study Using the National Health Insurance Claims Data

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          Abstract

          Background

          Childhood cancer survivors are at a high risk of medical consequences of their disease and treatment. There is growing information about the long-term health issues of childhood cancer survivors; however, there are very few studies describing the health care utilization and costs for this unique population. Understanding their utilization of health care services and costs will provide the basis for developing strategies to better serve these individuals and potentially reduce the cost.

          Objective

          This study aims to determine the utilization of health services and costs for long-term survivors of childhood cancer in Taiwan.

          Methods

          This is a nationwide, population-based, retrospective case-control study. We analyzed the claims data of the National Health Insurance that covers 99% of the Taiwanese population of 25.68 million. A total of 33,105 children had survived for at least 5 years after the first appearance of a diagnostic code of cancer or a benign brain tumor before the age of 18 years from 2000 to 2010 with follow-up to 2015. An age- and gender-matched control group of 64,754 individuals with no cancer was randomly selected for comparison. Utilization was compared between the cancer and no cancer groups by χ2 test. The annual medical expense was compared by the Mann-Whitney U test and Kruskal-Wallis rank-sum test.

          Results

          At a median follow-up of 7 years, childhood cancer survivors utilized a significantly higher proportion of medical center, regional hospital, inpatient, and emergency services in contrast to no cancer individuals: 57.92% (19,174/33,105) versus 44.51% (28,825/64,754), 90.66% (30,014/33,105) versus 85.70% (55,493/64,754), 27.19% (9000/33,105) versus 20.31% (13,152/64,754), and 65.26% (21,604/33,105) versus 59.36% (38,441/64,754), respectively (all P<.001). The annual total expense (median, interquartile range) of childhood cancer survivors was significantly higher than that of the comparison group (US $285.56, US $161.78-US $535.80 per year vs US $203.90, US $118.98-US $347.55 per year; P<.001). Survivors with female gender, diagnosis before the age of 3 years, and diagnosis of brain cancer or a benign brain tumor had significantly higher annual outpatient expenses (all P<.001). Moreover, the analysis of outpatient medication costs showed that hormonal and neurological medications comprised the 2 largest costs in brain cancer and benign brain tumor survivors.

          Conclusions

          Survivors of childhood cancer and a benign brain tumor had higher utilization of advanced health resources and higher costs of care. The design of the initial treatment plan minimizing long-term consequences, early intervention strategies, and survivorship programs have the potential to mitigate costs of late effects due to childhood cancer and its treatment.

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          Most cited references63

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          Cancer Statistics, 2021

          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2017) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long-term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one-half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%-2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2-year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers.
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            The central role of the propensity score in observational studies for causal effects

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              Cancer treatment and survivorship statistics, 2019

              The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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                Author and article information

                Contributors
                Journal
                JMIR Public Health Surveill
                JMIR Public Health Surveill
                JPH
                JMIR Public Health and Surveillance
                JMIR Publications (Toronto, Canada )
                2369-2960
                2023
                2 March 2023
                : 9
                : e42350
                Affiliations
                [1 ] Cancer Center Taipei Medical University Hospital Taipei Taiwan
                [2 ] Taipei Cancer Center Taipei Medical University Taipei Taiwan
                [3 ] Department of Pediatrics City of Hope National Medical Center Duarte, CA United States
                [4 ] Graduate Institute of Business Administration College of Management Fu Jen Catholic University New Taipei City Taiwan
                [5 ] Artificial Intelligence Development Center Fu Jen Catholic University New Taipei City Taiwan
                [6 ] Department of Applied Statistics and Information Science Ming Chuan University Taoyuan City Taiwan
                [7 ] Department of Pediatrics School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
                [8 ] Department of Pediatrics Taipei Medical University Hospital Taipei Taiwan
                [9 ] Taipei Medical University Research Center of Cancer Translational Medicine Taipei Medical University Taipei Taiwan
                [10 ] Division of Pediatric Gastroenterology, Department of Pediatrics Shuang Ho Hospital Ministry of Health and Welfare New Taipei Taiwan
                [11 ] Department of Pediatrics Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan
                Author notes
                Corresponding Author: Wan-Ling Ho 211002@ 123456h.tmu.edu.tw
                Author information
                https://orcid.org/0000-0003-1881-251X
                https://orcid.org/0000-0003-2854-8361
                https://orcid.org/0000-0002-7891-9514
                https://orcid.org/0000-0002-7571-3123
                https://orcid.org/0000-0002-9722-1998
                https://orcid.org/0000-0003-1421-0538
                Article
                v9i1e42350
                10.2196/42350
                10020904
                36862495
                d7b25978-d1d3-400f-b28b-3af85469ab4a
                ©James S Miser, Ben-Chang Shia, Yi-Wei Kao, Yen-Lin Liu, Shih-Yen Chen, Wan-Ling Ho. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 02.03.2023.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included.

                History
                : 4 September 2022
                : 8 November 2022
                : 13 December 2022
                : 22 January 2023
                Categories
                Original Paper
                Original Paper

                brain tumor,cancer survivor,children,cost of care,health care,health resource,leukemia,long-term follow-up,population-based study,solid tumor

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