How Well Do All Patient Refined–Diagnosis-Related Groups Explain Costs of Pediatric Cancer Chemotherapy Admissions in the United States?

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Russell, Heidi ; Street, Andrew ; Ho, Vivian (2016)
  • Publisher: American Society of Clinical Oncology
  • Journal: Journal of Oncology Practice, volume 12, issue 5, pages e564-e575 (issn: 1554-7477, eissn: 1935-469X)
  • Related identifiers: pmc: PMC5015448, doi: 10.1200/JOP.2015.010330
  • Subject: 36 | Health Policy | Original Contributions | 164
    mesheuropmc: health care economics and organizations | animal structures

Purpose: State-based Medicaid programs have begun using All Patient Refined–Diagnosis-Related Groups (APR-DRGs) to determine hospital reimbursement rates. Medicaid provides coverage for 45% of childhood cancer admissions. This study aimed to examine how well APR-DRGs reflect admission costs for childhood cancer chemotherapy to inform clinicians, hospitals, and policymakers in the wake of policy changes. Methods: We identified 25,613 chemotherapy admissions in the 2009 Kids’ Inpatient Database. To determine how well APR-DRGs explain costs, we applied a hierarchic linear regression model of hospital costs, allowing for a variety of patient, hospital, and geographic confounders. Results: APR-DRGs proved to be the most important predictors of admission costs (P < .001), with costs increasing by DRG severity code. Diagnosis, age, and hospital characteristics also predicted costs above and beyond those explained by APR-DRGs. Compared with admissions for patients with acute lymphoblastic leukemia, costs of admissions for patients with acute myelomonocytic leukemia were 82% higher; non-Hodgkin lymphoma, 20% higher; Hodgkin lymphoma, 25% lower; and CNS tumors, 27% lower. Admissions for children who were 10 years of age or older cost 26% to 35% more than admissions for infants. Admissions to children’s hospitals cost 46% more than admissions to other hospital types. Conclusion: APR-DRGs developed for adults are applicable to childhood cancer chemotherapy but should be refined to account for cancer diagnosis and patient age. Possible policy and clinical management changes merit further study to address factors not captured by APR-DRGs.
  • References (42)
    42 references, page 1 of 5

    1. Averill RF, Goldfield N, Hughes JS, et al: All Patient Refined Diagnosis Related Groups (APR-DRGs): Version 20.0-Methodology Overview. https://www.hcup-us.

    2. Florida Senate: 2011 Florida statutes 409.905. Statutes/2011/409.905

    3. Texas Medicaid & Healthcare Partnership: Hospital Services Handbook: Inpatient Reimbursement. 2011TMPPM-29-081.html

    4. California Department of Health Care Services: DRG reimbursement implementation.

    5. Ohio Department of Medicaid: Hospital payment policy. PROVIDERS/ProviderTypes/HospitalProviderInformation/HospitalPaymentPolicy.aspx

    6. New York Department of Health: Official compilation of the rules and regulations of the state of New York: Title 10 volume A-2-Section 86-1.23: Exempt units and hospitals. 8525652c00680c3e8525652c006eb454?OpenDocument

    7. Illinois General Assembly: Public Act 097-0689. publicacts/97/PDF/097-0689.pdf

    8. Price A, Stranges E, Elixhauser A: Pediatric Cancer Hospitalizations, 2009: HCUP Statistical Brief #132. Rockville, MD, US Agency for Healthcare Research and Quality, 2012,

    9. Russell HV, Okcu MF, Kamdar K, et al: Algorithm for analysis of administrative pediatric cancer hospitalization data according to indication for admission. BMC Med Inform Decis Mak 14:88, 2014

    10. Berry JG, Hall M, Hall DE, et al: Inpatient growth and resource use in 28 children's hospitals: A longitudinal, multi-institutional study. JAMA Pediatr 167: 170-177, 2013

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