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Cost-effectiveness of improving pediatric hospital care in Nicaragua
Edward I Broughton1, Ivonne Gomez, Oscar Nuñez
1Health Care Improvement Project, United States Agency for International Development, University Research Co., LLC, Bethesda, Maryland, United States of America. ebrought@jhsph.edu
Insights
An intervention to improve pediatric care in Nicaragua reduced hospital stays and deaths for diarrhea and pneumonia, proving cost-saving. This quality improvement initiative demonstrated significant health benefits without increasing healthcare costs.
Area of Science:
- Health Economics
- Pediatric Infectious Diseases
- Public Health Interventions
Background:
- Improving the quality of care for childhood illnesses like diarrhea and pneumonia is crucial in resource-limited settings.
- Nicaragua faces significant burdens from these diseases, necessitating effective and cost-efficient interventions.
Purpose of the Study:
- To evaluate the costs and cost-effectiveness of a quality improvement intervention for pediatric diarrhea and pneumonia care.
- To assess the impact of the intervention on hospital length of stay (LOS), mortality, and healthcare expenditures.
Main Methods:
- A quasi-experimental design comparing pre-intervention (2003) and post-intervention (2006) data from 14 Nicaraguan hospitals.
- Analysis of 1294 pre-intervention and 1505 post-intervention clinical records for LOS and mortality.
- Calculation of hospitalization costs using hospital, Ministry of Health, and private sector data; intervention costs from project records.
- Decision-tree analysis to determine incremental cost-effectiveness and disability-adjusted life years (DALYs) averted.
Main Results:
- Average LOS decreased for diarrhea (3.87 to 3.55 days) and pneumonia (4.23 to 3.94 days).
- Case fatality rates declined for diarrhea (45/10,000 to 30/10,000) and pneumonia (34/10,000 to 27/10,000).
- Total hospitalization and antibiotic costs decreased from US$451 to US$437, with the intervention being cost-saving in terms of DALYs averted.
Conclusions:
- The intervention led to reduced LOS and mortality for diarrhea, and reduced LOS for pneumonia, without increasing costs.
- The quality improvement initiative demonstrated potential cost-savings, suggesting its effectiveness in improving pediatric care outcomes in Nicaragua.
Objective:
To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures.
Methods:
Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness.
Results:
Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204).
Conclusions:
After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.
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