To estimate the direct medical care costs of childhood cancer from a health system perspective, and to determine which elements influence these costs.

Research Questions

Using cancer registry and administrative data linked within each of BC and ON, we propose to:
  1. Estimate the costs of care overall and for four groups of childhood cancer (3 most common types: leukemia, central nervous system tumours, and lymphoma, and a fourth consisting of all other cancers) for three phases of care: initial, continuing/survivor, and terminal.
  2. Determine the main sociodemographic, clinical, and health system predictors of costs, overall and for each cancer group, and each costing phase.
  3. Measure time trends in health service utilization and costs during the first year after diagnosis, overall and for each childhood cancer group and relate temporal changes to changes in treatment and the frequency of late complications.
  4. Estimate 1-year, 5-year, and 10-year costs overall and for the most common cancers using the phase-based costing approach and appropriate statistical methods.

Inclusion Criteria

Study cohorts will be identified from the Childhood/Adolescent/Young Adult Cancer Survivors (CAYACS) Research Program at the British Columbia Cancer Agency and the Pediatric Oncology Group of Ontario Network Information System (POGONIS) at the Pediatric Oncology Group of Ontario (POGO). We will select patients diagnosed from January 1, 1995, to December 31, 2010, at ages 0 to 19 years with a cancer or tumour included in the International Classification of Childhood Cancers (ICCC).

Exclusion Criteria

We will exclude patients who have an incorrect or missing histology code, a date of diagnosis that is the same as the date of death, not residents of British Columbia or Ontario at diagnosis, or do not have a valid Medical Services Plan number or Ontario Health Insurance Plan number.

Design and Methods

Each province will work with its own data. In Ontario, all analyses will be conducted at the Institute for Clinical Evaluative Sciences. We will link the cases identified in POGONIS to their health care administrative data and determine use and estimate costs for the following health care resources: inpatient hospitalization, emergency department visits, lab and diagnostic tests, physician services, prescription drugs, chemotherapy, radiation therapy, palliative care. home care. We will also estimate net cancer-related costs by identifying a non-cancer control group. Total and net health care costs will be estimated and analyzed to address the research questions.

Study Timeline

July 2012 - December 2015

Progress: Costs for 90 days before diagnosis and one year after diagnosis, phase-specific costs,and time trends in first-year costs have been estimated for the childhood cancer cohort in Ontario. Estimation of costs for longer time periods is underway. An oral presentation on first-year costs was givenat the conference of The Canadian Association for Population Therapeutics , November 1 – 3, 2015 in Toronto, Ontario. A manuscript is being prepared for journal submission. Other manuscript preparation is underway.


Research Team

Murray Krahn, MD, MSc, FRCPC
Mary McBride Mark Greenberg
Paul Nathan
Paul Rogers
Stuart Peacock
Karen E. Bremner, BSc


Canadian Institutes of Health Research