Hospitalization burden among children and adolescents diagnosed with leukemia and lymphoma by treatment modalities in the US.

19 Background: Leukemia and lymphoma are among the most common pediatric and adolescent cancers in the US, which often require hospital-based multimodal treatments, including chemotherapy, radiation therapy, immunotherapy, and stem cell transplantation. To date, little is known about hospitalization burden, including hospitalization cost. Methods: The cross-sectional 2019 Kids' Inpatient Database, which is part of the nationally representative Healthcare Cost and Utilization Project data, was used to identify hospitalizations for children and adolescents aged 0–18 years treated for leukemia or lymphoma. Treatment was classified as: 1) chemotherapy only; 2) stem cell transplant with chemotherapy; 3) transplant without chemotherapy; and 4) others. Multivariable negative binomial regression and log-normal regression were used to examine length of stay (LOS) and total hospital cost by modality, respectively. Patient- and hospital- level characteristics included in adjusted analyses were age, sex, primary payer, hospital bed size, and hospital region. Sample weights were used to generate national estimates. Results: A total of 9,221 hospitalizations were identified, representing 12,294 hospitalizations nationwide. Among these, 6,438 (52.4%) involved chemotherapy alone, 163 (1.3%) involved both chemotherapy and stem cell transplantation, 78 (0.6%) involved stem cell transplantation without chemotherapy, and the remaining 5,615 (45.7%) received other types of treatment. The median hospitalization costs ranged from $18,430 for chemotherapy only to $239,492 for transplantation with chemotherapy and LOS ranged from 5 days to 41 days, respectively. In multivariable regressions, transplantation with chemotherapy and transplantation without chemotherapy were associated with substantially higher hospitalization costs and longer LOS compared to chemotherapy only (Table; all p < .001). Conclusions: Hospitalization burden among children diagnosed with leukemia and lymphoma varies substantially by treatment modality, with stem cell transplantation combined with chemotherapy being associated with the longest LOS and highest hospital costs. These findings may inform efforts to improve financial and logistical support for affected families. Treatment modality Hospitalization cost Multiplicative change in median cost LOS (days) Multiplicative change in LOS Median IQR Median IQR Chemotherapy only $18,430 ($8,342, $52,998) ref 5 (3, 13) ref Transplant with chemotherapy $239,492 ($139,743, $398,797) 5.2 (4.3, 6.3) 41 (31, 64) 10.8 (9.2, 12.7) Transplant without chemotherapy $238,652 ($118,996, $344,741) 4.1 (3.3, 5.0) 37 (28, 52) 9.3 (7.1, 12.3) Other treatments $9,803 ($5,346, $20,307) 0.6 (0.5, 0.7) 3 (2, 6) 0.5 (0.5, 0.6)