OBJECTIVES: Relapsed pediatric B-cell ALL is a disease characterized by extremely poor prognosis, as well as recurrence and hospitalizations. To estimate the real-world economic burden of pediatric patients with relapsed B-cell ALL in the US, a claims database analysis was performed.

METHODS: The MarketScan^® Commercial and Medicare Supplemental Databases were queried for cases from 4/11/2011‑2/28/2018. Eligible cases included patients <18 years old with at least one inpatient claim, or at least two outpatient claims at least 30 days apart for relapsed ALL, with drug and medical coverage on the date of first relapsed ALL diagnosis (the index date). Patients with medicines for T-cell ALL were excluded. Patients were followed from the index date until the earliest of: inpatient death, the end of continuous enrollment, the end of the study period, or for 18 weeks post-index date. Hospitalizations and plan-paid costs (in 2018 dollars) were calculated at the admission level and patient level.

RESULTS: A total of 307 pediatric patients with relapsed B-cell ALL were identified with a mean (median) follow-up of 117 (126) days. Mean (standard deviation [SD]) age was 9.5 (4.5) years. The mean (SD) length of stay (LOS) per hospitalization was 10 (14) days at a cost of $112,542 ($370,715). At the patient level, the mean (SD) total number of inpatient hospitalizations per patient was 4 (2). Mean (SD) total inpatient LOS per patient was 39 (29) days. Mean (SD) total inpatient cost per patient was $463,000 ($767,623) and mean (SD) total outpatient cost per patient was $82,189 ($98,340). Mean (SD) total outpatient pharmacy cost per patient was $4,195 ($7,366). The total mean (SD) healthcare cost per patient was $549,384 ($780,539).

CONCLUSIONS: Pediatric patients with relapsed B-cell ALL have substantial healthcare resource use and economic burden. Innovative treatments that can improve outcomes and potentially reduce hospitalizations, and thus, economic burden, are needed.