Excess healthcare expenditure in adults treated for solid cancer in childhood: a cohort study in France

Daniel Bejarano-Quisoboni (), Henri Panjo, Brice Fresneau, Chiraz El‑Fayech, François Doz, Aurore Surun, Florent Vathaire and Nathalie Pelletier-Fleury
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Daniel Bejarano-Quisoboni: CESP, Inserm
Henri Panjo: CESP, Inserm
Brice Fresneau: CESP, Inserm
Chiraz El‑Fayech: Gustave Roussy
François Doz: SIREDO Center (Care, Research, Innovation in Pediatric, Adolescents and Young Adults Oncology), Institut Curie
Aurore Surun: SIREDO Center (Care, Research, Innovation in Pediatric, Adolescents and Young Adults Oncology), Institut Curie
Florent Vathaire: CESP, Inserm
Nathalie Pelletier-Fleury: CESP, Inserm

The European Journal of Health Economics, 2024, vol. 25, issue 3, No 10, 513-523

Abstract: Abstract Background Due to late effects, childhood cancer survivors (CCS) are more likely to have multiple chronic conditions than the general population. However, little is known about the economic burden of care of CCS in the long term. Objectives To estimate excess healthcare expenditure for long-term CCS in France compared to the general population and to investigate the associated factors. Methods We included 5353 5-year solid CCS diagnosed before the age of 21 years before 2000 from the French CCS cohort and obtained a random reference sample from the general population for each CCS, matched on age, gender and region of residence. We used the French national health data system to estimate annual healthcare expenditure between 2011 and 2018 for CCS and the reference sample, and computed the excess as the net difference between CCS expenditure and the median expenditure of the reference sample. We used repeated-measures linear models to estimate associations between excess healthcare expenditure and CCS characteristics. Results Annual mean (95% CI) excess healthcare expenditure was €3920 (3539; 4301), mainly for hospitalization (39.6%) and pharmacy expenses (17%). Higher excess was significantly associated with having been treated before the 1990s and having survived a central nervous system tumor, whereas lower excess was associated with CCS who had not received treatment with radiotherapy. Conclusions Of the variables that influence excess healthcare expenditure, a lever for action is the type of treatment administered. Future research should focus on addressing the long-term cost-effectiveness of new approaches, especially those related to radiotherapy.

Keywords: Economic burden; Childhood cancer; Late effects; France (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-023-01606-6

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