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The cost of childhood intussusception in Ontario from 2003 to 2016: A population-based study
Mercedes Pilkington1, Edrea Khong2, Susan B Brogly3
1Department of Surgery, Queen's University, Kingston Health Sciences Centre, 76 Stuart St., Kingston, ON, Canada K7L 2V7.
Insights
Non-surgical management of pediatric intussusception is the most cost-effective treatment. Successful non-surgical reduction and early discharge can significantly reduce healthcare costs for intussusception care.
Area of Science:
- Pediatric Gastroenterology
- Health Economics
- Healthcare Management
Background:
- Pediatric intussusception management has shifted towards non-surgical approaches.
- The economic impact of these management changes remains unclear.
Purpose of the Study:
- To evaluate the healthcare costs associated with different pediatric intussusception treatment modalities.
- To analyze cost trends over time and identify factors influencing cost.
Main Methods:
- Retrospective longitudinal cohort study using population-based administrative healthcare data (2003-2016) in Ontario, Canada.
- Inclusion of emergency department, hospitalization, and physician billing costs.
- Analysis of costs by treatment modality (non-surgical, failed non-surgical, surgical only) and hospital type.
Main Results:
- Non-surgical management had the lowest median hospital-associated costs ($2467) compared to failed non-surgical ($6508) and surgical only ($8863).
- Costs for failed non-surgical management significantly increased from 2003 to 2016.
- Community hospitals incurred higher costs than academic hospitals.
Conclusions:
- Treatment modality significantly impacts the cost of pediatric intussusception care, with non-surgical management being the least expensive.
- Standardizing care to optimize successful non-surgical reduction and early discharge may lead to substantial healthcare cost savings.
Background:
Management of pediatric intussusception has evolved to favor non-surgical reduction with potential outpatient management. The overall impact of these changes on healthcare costs is unknown.
Methods:
A retrospective longitudinal cohort study was conducted utilizing population-based universal-access administrative healthcare data to identify patients <18 years treated for intussusception January 2003-December 2016 in Ontario, Canada. Hospital-associated cost included emergency department and cost of hospitalization, while total cost also included billable physician costs. All costs are presented in 2016 Canadian Dollars.
Results:
The median hospital-associated costs for each modality were: non-surgical $2467, failed non-surgical $6508, and surgical only $8863 (p < 0.0001). Costs associated with non-surgical or surgical only management did not change over the study period, whereas costs associated with failed non-surgical management increased from $3842 in 2003 to $12,350 in 2016 (p = 0.0003). Similar trends were observed when physician billing data was included. Costs were $1076.95 higher in community hospitals than academic hospitals (95% CI: $344, $1810; p = 0.004).
Conclusion:
The cost of care for intussusception is dependent upon treatment modality and was lowest for non-surgical management and highest for patients treated in community hospitals. Efforts to standardize care to promote successful non-surgical management and to facilitate early discharge could provide cost savings to the healthcare system.
Type Of Study:
Cost Effectiveness Study.
Level Of Evidence:
IV.
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