Utilization and Cost of Outpatient Rehabilitation Services for Pediatric Patients Treated for Acute Lymphoblastic Leukemia

Research Objectives: Over the past 10 years, calls have been increasing for rehabilitative care for pediatric cancer patients to address function and quality of life issues. The extent to which these services have been incorporated into the care of patients is unclear. This study investigates the temporal trends and factors associated with outpatient rehabilitation utilization and costs for patients with the most common form of childhood cancer, acute lymphoblastic leukemia (ALL).

Design: De-identified, longitudinal health information on patients who represent a mixture of ages, ethnicities, and geographical regions across the United States was accessed to assess outpatient rehabilitation utilization over the time period of 1993-2017. Regression models were constructed to assess associations with age, sex, race and ethnicity, year of diagnosis, and region of the country treated.

Setting: Optum Labs Data Warehouse

Participants: Data from patients aged 1-30 years with a new diagnosis of ALL and continuous insurance coverage for 36 months post-diagnosis was included.

Interventions: None

Main Outcome Measures: Outcomes of interest included outpatient rehabilitation service utilization and cost based on charge codes, summarized over 36 months after cancer diagnosis.

Results: In the cohort of 1000 patients, utilization of an outpatient rehabilitation service increased from 20% for patients diagnosed in 1993-2002 to 55% in 2013-2017. Inflation adjusted cost for provision of services, for those who received them, did not change significantly across time. Importantly, inflation adjusted costs of these supportive care services remained low, accounting for a median of 1.3% (Q1, Q3 0.3, 3.4) in 1993-2002 and decreasing to a median 0.4% (Q1, Q3, 0.1, 1.0) in 2013-2017. Factors that influenced decreased likelihood of outpatient rehabilitation service utilization, apart from year of diagnosis, was receiving care in a region other than the Midwest.

Conclusions: Although outpatient rehabilitation services are being increasingly provided to patients with ALL, the relative cost per patient is low and geographic variability in care utilization is evident.

Author(s) Disclosures: Funding was provided by: National Cancer Institute (CA234232), Children's Cancer Research Fund, and the Pine Tree Apple Classic Fund. No other conflicts are present.