JMIR Publications

ABSTRACT

Background:

Childhood cancer survivors are at 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 healthcare utilization and costs for this unique population. Understanding their utilization of healthcare services and its cost will provide the basis for developing strategies to better serve these individuals and potentially reduce the cost.

Objective:

The aim of this study was 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 Taiwan 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 year 2000 to 2010 with follow-up to 2015. An age- and gender-matched control group of 64,754 individuals with no cancer were randomly selected for comparison. Utilization was compared between the cancer and no cancer groups by χ2 test. The annual medical expense was compared by Mann–Whitney U test and Kruskal–Wallis rank sum test.

Results:

At a median follow-up of 7 years, childhood cancer survivors had a significantly higher proportion utilizing medical center, regional hospital, inpatient, and emergency services in contrast to no cancer individuals (57.9% vs. 44.5%, 90.7% vs. 85.7%, 27.2% vs. 20.3%, and 65.3% vs. 59.4%, respectively; all P<.001). The annual total expense of childhood cancer survivors was significantly higher than that of the comparison group (median [interquartile range], 285.56 [161.78–535.80] vs. 203.90 [118.98–347.55] USD/year, P<.001). Survivors with female gender, diagnosis before the age of 3 years, or diagnosis of brain cancer and benign brain tumor had significantly higher annual outpatient expenses. Moreover, the analysis of outpatient medication costs showed that hormonal and neurological medications comprised the two 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.