Standardized costs and outcome in children treated with gemtuzumab on the AAML0531 trial: A report from the Children’s Oncology Group.
Bibliographic record
Abstract
7086 Background: NCI-funded cooperative group oncology group trials report clinical outcomes but do not report cost estimates. The Children’s Oncology Group trial AAML0531 randomized 1,022 de novo AML patients to standard chemotherapy ± gemtuzumab (GMTZ). As previously reported, GMTZ improved event-free survival but did not improve overall survival. The Pediatric Health Information Systems (PHIS) database contains standardized inpatient cost data (SC) on children treated at 43 freestanding pediatric hospitals in the United States. We hypothesized that SC would be similar for both treatment arms during on-protocol therapy but lower in the GMTZ arm during all follow up time (defined as time from on-protocol to last COG follow-up). Methods: Data from AAML0531 and PHIS were probabilistically merged. PHIS SC were defined by hospital costs multiplied by the ratio of cost to charges and adjusted by consumer price index and geographical region. All available SC were extracted for all merged patients and compared with bivariate statistics. Results: Merged patients (n = 373) were representative of the overall trial population. Follow-up time was marginally longer in the GMTZ arm, 223 days vs 238 days, p = 0.1. The overall median SC was $309,785 ($1,943/day) on-protocol and $467,767 ($1,707/day) for all follow-up time. The per day SC did not differ by study arm on-protocol but per day SC were significantly higher in the non-GTMZ arm, $1,877/day vs $1,648/day over all follow-up time, p = 0.03. Table 1 summarizes departmental SC; Room and Board (RB) comprises approximately 50-60% of all SC. Conclusions: Merging of PHIS data with COG data enables estimation of regimen specific SC. GMTZ does not increase SC during protocol therapy but is associated with lower per day SC over all follow-up time. Further work is needed to increase the number of patients with SC data, to examine SC variability, and define drivers of SC. Clinical trial information: NCT00372593. Department Median on protocol Percent* Median overall Percent* Pharmacy 60,866 19.6% 99,881 21% Supplies 3,419 1.1% 5,101 1.1% Laboratory 34,460 11.1% 54,786 11.7% Radiology 4,523 1.5% 7,146 1.5% Clinical 8,282 2.7% 19,142 4% RB 181,774 58.7% 241,794 52% *Percentage of overall median SC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".