Hospitalization costs of severe bacterial pneumonia in children: comparative analysis considering different costing
Sheila Elke Araujo Nunes1,2, Ruth Minamisava2, Maria Aparecida da Silva Vieira3
1Universidade Estadual da Região Tocantina do Maranhão, Imperatriz, MA, Brazil.
Insights
Comparing hospitalization costs for childhood bacterial pneumonia in Brazil revealed that micro-costing methods (medical record review and therapeutic guidelines) yielded similar results. Gross-costing using Brazilian Public Unified Health System reimbursement rates produced significantly lower estimates.
Area of Science:
- Pediatrics
- Health Economics
- Infectious Diseases
Background:
- Community-acquired pneumonia (CAP) is a significant cause of childhood hospitalization.
- Accurate cost-of-illness studies are crucial for healthcare resource allocation.
- The Brazilian Public Unified Health System (SUS) perspective requires specific costing methodologies.
Purpose of the Study:
- To determine and compare hospitalization costs for bacterial CAP in children.
- To evaluate different costing methods from the SUS perspective.
- To identify the most reliable and efficient costing approach.
Main Methods:
- A cost-of-illness study utilizing primary data from 59 hospitalized children with bacterial pneumonia.
- Employed three costing methods: micro-costing (medical record review), micro-costing (therapeutic guidelines), and gross-costing (SUS reimbursement rates).
- Compared cost estimates using the Friedman test.
Main Results:
- Inpatient costs for severe pneumonia were R$ 780.70 (medical record review), R$ 641.90 (therapeutic guidelines), and R$ 594.80 (SUS reimbursement rates).
- Micro-costing methods (record review and guidelines) yielded statistically similar cost estimates (p=0.405).
- Gross-costing estimates were significantly lower than both micro-costing methods (p<0.001 and p=0.006).
Conclusions:
- Costing methodologies significantly impact hospitalization cost estimates for bacterial CAP in children under the SUS.
- Micro-costing based on therapeutic guidelines offers a practical and cost-effective alternative for estimating these costs.
- The SUS reimbursement rate method underestimates the true hospitalization costs.
Objective:
To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective.
Methods:
Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test.
Results:
Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (p<0.001) or record review (p=0.006).
Conclusion:
Brazilian Public Unified Health System costs estimated via different costing methods differ significantly, with gross-costing yielding lower cost estimates. Given costs estimated by different micro-costing methods are similar and costing methods based on therapeutic guidelines are easier to apply and less expensive, this method may be a valuable alternative for estimation of hospitalization costs of bacterial community-acquired pneumonia in children.
Objetivo:
Determinar e comparar custos hospitalares no tratamento da pneumonia bacteriana adquirida na comunidade por diferentes metodologias de custeio, na perspectiva do Sistema Único de Saúde.
MéTodos:
Estudo de custo, com coleta de dados primários de uma amostra de 59 crianças com 28 dias a 35 meses de idade hospitalizadas por pneumonia bacteriana. Foram considerados custos diretos médicos e não médicos. Três metodologias de custeio foram utilizadas: microcusteio por revisão de prontuários, microcusteio considerando diretriz terapêutica e macrocusteio por ressarcimento do Sistema Único de Saúde. Os custos estimados pelas diferentes metodologias foram comparados utilizando o teste de Friedman.
Resultados:
Os custos hospitalares de crianças com pneumonia grave foram R$ 780,70 ($Int. 858.7) por revisão de prontuários, R$ 641,90 ($Int. 706.90) por diretriz terapêutica e R$ 594,80 ($Int. 654.28) por ressarcimento do Sistema Único de Saúde, respectivamente. A utilização de metodologias de microcusteio (revisão de prontuários e diretriz) resultou em estimativas de custos equivalentes (p=0,405), enquanto o custo estimado por ressarcimento foi significativamente menor do que aqueles estimados por diretriz (p<0,001) e por revisão de prontuário (p=0,006), sendo, assim, significativamente diferentes.
ConclusãO:
Na perspectiva do Sistema Único de Saúde, existe diferença significativa nos custos estimados quando se utilizam diferentes metodologias, sendo a estimativa por ressarcimento a que resulta em valores menores. Considerando que não há diferença nos valores de custos estimados por diferentes metodologias de microcusteio, a metodologia de custeio por diretriz, de mais fácil e rápida execução, é uma alternativa válida para estimativa de custos de hospitalização por pneumonias bacterianas em crianças.
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