Physician Claims and Hospitalizations for Pediatric Cancer Survivors after Receiving Proton Radiotherapy Compared to Photon Radiotherapy: Real-World Data from 2010-2022

Abstract

Objectives

Proton radiotherapy (PRT) is predicted to have fewer late-effects compared to photon radiotherapy (PHT) in survivors of childhood cancers. While PRT is more costly upfront, the reduction in long-term morbidity is expected to result health-systems savings. In this study, we use real-world data (RWD) to compare physician claims and discharge abstract database (DAD) data in a cohort of pediatric patients receiving PRT/PHT.

Methods

Using the Alberta Health Services (AHS) pediatric database; we identified those receiving radiotherapy (RT) between 2010-2022 who met AHS guidelines for PRT. Data from the Alberta Pediatric Cancer Survivors cohort was abstracted including physician claims and DAD data (after completion of RT). Univariate analysis was performed using t-test (sig. p<0.05).

Results

Records for 182 patients were reviewed: 28 patients (15.4%) received PRT. Median follow-up (FU) from RT was not different between PRT (8.5yrs, SD=2.7yrs) and PHT (9.1yrs, SD=3.1 yrs)(p=0.053). The average number of outpatient visits was lower for PRT (M= 114.0, SD=94.5) vs PHT (M=179.0, SD=201.5) (p=0.005). Regarding inpatient hospitalizations, the length of stay (LOS) was lower for PRT (PRT M=30.7, SD=30.2) vs PHT (M=52.0, SD=56.9, p=0.017). To compare patients with similar anticipated treatment-related morbidity, we reviewed patients with CNS primaries (PRT=25, PHT=63). Health-care practitioner claims for CNS patients was lower for PRT (M= 78.1[4-250]) vs PHT (mean=149.1 [1-119])(p=0.024). We reviewed LOS data for CNS patients and quantified days of admission per year of FU. Patients receiving PRT had a lower LOS per year of FU (mean= 0.41/yr [0/yr-5.14/yr]) vs PHT (mean= 2.11/yr [0/yr-44.03/yr]). With an estimated cost of $2000/day for hospital admission, the mean cost of admission over the entire length of FU per patient was almost 5 times higher for PHT (PRT=$8080 vs PHT=$38370).

Conclusions

RWD shows that PRT is associated with reduced outpatient physician visits and LOS after completion of RT compared to PHT. With reductions of LOS, there is potential cost savings of approximately $30,650 over a median FU of 8.5 years per patient.