Microcosting of Childhood Hodgkin Lymphoma Treatment Across Resource Levels Using the Adapted Resource and Implementation Application Guidelines in the US

PURPOSE Childhood Hodgkin lymphoma comprising 40%-45% of pediatric lymphomas is curable with multimodal therapy, but optimal treatment access remains limited in many settings. The Adapted Resource and Implementation Application (ARIA) guidelines provide resource-stratified, evidence-based regimens to support equitable care delivery across diverse health systems. To inform implementation and global decision making, understanding cost implications across ARIA-defined clinical choices is critical. METHODS We conducted a top-down microcosting analysis from a US payer perspective to evaluate costs across ARIA risk groups and resource-based strata. An ingredient-based framework was developed guided by ARIA and validated with expert input. Unit costs (2024 US dollars) were retrieved from Centers for Medicare & Medicaid Services, IQVIA, and St Jude Children's Research Hospital. Costs were calculated for pretreatment, treatment, and 5-year follow-up phases across ARIA risk groups and strata (A-E). Essential services included core clinical care, while essential + recommended added advanced laboratories and imaging. RESULTS Total per-patient costs ranged from $24,116 US dollars (USD) to $189,244 USD. Essential pretreatment costs were $8,783 USD versus $9,689 USD-$11,321 USD for essential + recommended. Treatment costs rose with risk level and resource strata: $6,285 USD-154,316 (essential) and $7,182 USD-168,875 (essential + recommended). Substituting vincristine with brentuximab vedotin increased chemotherapy costs from $2,510 USD to $147,118 USD across risk groups. Radiotherapy costs ranged from $7,304 USD to $19,355 USD. Follow-up costs were $9,048 USD, across strata. CONCLUSION This first ARIA-informed cost analysis demonstrates how resource-driven clinical decisions shape cost with conventional treatment representing a fraction of regimens incorporating novel therapies. The proposed methodology provides a scalable blueprint for future costing across settings and cancer types to support adaptive Health Technology Assessment and guide investments toward equitable childhood cancer care.