Economic Evaluation of Pediatric Cancer Survivors after Receiving Proton Radiotherapy Compared to Photon Radiotherapy: Real-World Data from 2010-2022.

Proton radiotherapy (PRT) is associated with fewer late effects compared to photon radiotherapy (PHT) in selected survivors of childhood cancers. While PRT is more costly upfront, the reduction in long-term morbidity is expected to provide cost recovery to healthcare systems. We use real-world data (RWD) to compare physician claims and discharge abstract database (DAD) data in a cohort of pediatric patients receiving PRT or PHT. Using the Alberta Health Services (AHS) pediatric database, we identified those receiving radiotherapy (RT) between 2010 and 2022, inclusive, who met AHS guidelines for PRT referral to the United States. Patient demographics including follow-up time from RT start dates were determined. Data from the Alberta Pediatric Cancer Survivors cohort was abstracted including physician claims and DAD data after completion of RT. Canadian Institute for Health Information (CIHI) data was accessed to determine hospitalization costs per day for the year of admission. Univariate analysis was performed using the t-test at a significance level of 0.05. Records for 228 children were identified: 35 patients (15.4%) received PRT and 193 patients received PHT (84.7%). Median follow-up (FU) from RT was not different in children treated with PRT (6.34 years, IQR 5.16 years) and PHT (6.45 years, IQR 7.28 years, p = 0.509). The mean number of outpatient visits was lower following PRT (114.0, SD 94.5) vs PHT (179.0, SD 201.5, p = 0.005). Regarding inpatient hospitalizations, the mean length of stay (LOS) was lower after PRT (30.7 days, SD 30.2) vs PHT (52 days, SD 56.9, p = 0.017). We compared the cost of hospitalization 60 days post RT for the PRT and PHT groups. As patients receiving PRT received care of country, we 60 days post RT represented a time both groups would be eligible to receive care at home. The mean cost of hospitalization for the PRT group 60 days post RT was $5337.57 (SD = $7919.88). Comparatively the mean cost of hospitalization 60 days post RT for the photon group was $7053.25 (SD = $15.751.83). The trend towards higher cost of hospitalization seen for the PHT was not statistically significant (p = 0.07). PRT is associated with reduced outpatient physician visits and LOS after completion of RT compared to PHT using RWD. With reductions in LOS, there is potential cost savings with a lower mean cost of hospitalization 60 days post RT seen in the PRT group. While this trend did not reach statistical significance, small numbers of patients were represented in the PRT group. Assessment of claims cost and hospitalization costs over the entire follow-up period for this cohort of patients is planned. [ABSTRACT FROM AUTHOR]