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Cost analysis of pediatric intensive care: a low-middle income country perspective
Amrit Kaur1, Muralidharan Jayashree2, Shankar Prinja3
1Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Insights
Pediatric intensive care unit (PICU) costs are high, with out-of-pocket expenses significant in low-income countries. This study details health system and patient costs for PICU stays, finding severe illness and ventilation increase expenses.
Area of Science:
- Health Economics
- Pediatric Critical Care
- Cost Analysis
Background:
- Pediatric Intensive Care Unit (PICU) admissions represent a substantial global healthcare expense.
- Out-of-pocket (OOP) expenditure is a major financial burden for families in low- and middle-income countries.
- Understanding the true cost of pediatric intensive care is crucial for financial planning and policy development.
Purpose of the Study:
- To determine the health system cost associated with PICU admissions.
- To quantify the out-of-pocket (OOP) expenditure incurred by patients during their PICU stay.
- To analyze cost drivers and provide data for reimbursement frameworks.
Main Methods:
- A prospective study utilizing bottom-up micro-costing methods was conducted in a tertiary-level PICU.
- Health system resource utilization data were collected over a 12-month period (2018).
- Out-of-pocket expenditure data were gathered from 299 patients over an 18-month period (July 2017-December 2018).
Main Results:
- The average cost per patient treated in the PICU was US$ 2078.
- Health system costs averaged US$ 1731 per patient, while OOP expenditure averaged US$ 352.
- Ventilated patients incurred approximately double the OOP expenditure compared to non-ventilated patients.
Conclusions:
- Fixed costs constituted a significantly larger portion (3.8 times) of PICU care expenses than variable costs.
- The majority of PICU care costs were absorbed by the hospital system.
- Factors such as severe illness, prolonged ICU stay, and mechanical ventilation were directly correlated with increased healthcare costs.
Background:
Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. In low middle-income countries, out of pocket expenditure (OOP) constitutes a major portion of the total expenditure. This makes it important to gain insights into the cost of pediatric intensive care. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during PICU stay.
Methods:
Prospective study conducted in a state of the art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January to December 2018. Data regarding OOP was collected from 299 patients admitted from July 2017 to December 2018. The latter period was divided into four intervals, each of four and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient's perspective.
Results:
The median (inter-quartile range, IQR) length of PICU stay was 5(3-8) days. Mean ± SD Pediatric Risk of Mortality Score (PRISM III) score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non- ventilated child.
Conclusions:
The fixed cost of PICU care was 3.8 times more than variable costs. Major portion of cost was borne by the hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary level intensive care in a public sector teaching hospital in India is far less expensive than developed countries.
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