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Health care utilization and costs following Kawasaki disease
Cal Robinson1, Rahul Chanchlani2, Anastasia Gayowsky3
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
Children diagnosed with Kawasaki disease (KD) experience significantly higher healthcare utilization and costs compared to their peers. This highlights the substantial burden of KD on healthcare systems.
Area of Science:
- Pediatric Health
- Rheumatology
- Health Services Research
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- The incidence of KD is increasing in Canada, leading to significant healthcare expenditures.
- Limited data exists on healthcare utilization and associated costs after initial KD hospitalization.
Purpose of the Study:
- To determine the rates of healthcare utilization following a Kawasaki disease diagnosis.
- To analyze the associated healthcare costs in children diagnosed with KD.
- To assess the long-term impact of KD on healthcare resource consumption.
Main Methods:
- Utilized population-based health administrative databases in Ontario, Canada (1995-2018).
- Identified children (0-18 years) hospitalized for KD and matched them to 100 unexposed controls.
- Primary outcomes included hospitalization, emergency department (ED), and outpatient physician visits; secondary outcomes were healthcare costs.
Main Results:
- Compared 4,597 KD cases to 459,700 controls, finding higher rates of hospitalization (aRR 2.07), outpatient visits (1.30), and ED visits (1.22) in KD cases.
- Within one year post-discharge, 15.6% of KD cases were re-hospitalized, and 45.5% had an ED visit.
- KD cases incurred substantially higher healthcare costs, with median first-year costs of $2466 CAD versus $234 CAD for controls.
Conclusions:
- Children with Kawasaki disease exhibit elevated healthcare utilization and costs post-diagnosis compared to non-exposed children.
- The increasing incidence and associated costs of KD pose a significant challenge to healthcare systems.
- Further research into long-term management and cost-effectiveness is warranted for Kawasaki disease.
Objectives:
Kawasaki disease (KD) is a common childhood vasculitis with increasing incidence in Canada. Acute KD hospitalizations are associated with high health care costs. However, there is minimal health care utilization data following initial hospitalization. Our objective was to determine rates of health care utilization and costs following KD diagnosis.
Methods:
We used population-based health administrative databases to identify all children (0 to 18 years) hospitalized for KD in Ontario between 1995 and 2018. Each case was matched to 100 nonexposed comparators by age, sex, and index year. Follow-up continued until death or March 2019. Our primary outcomes were rates of hospitalization, emergency department (ED), and outpatient physician visits. Our secondary outcomes were sector-specific and total health care costs.
Results:
We compared 4,597 KD cases to 459,700 matched comparators. KD cases had higher rates of hospitalization (adjusted rate ratio 2.07, 95%CI 2.00 to 2.15), outpatient visits (1.30, 95%CI 1.28 to 1.33), and ED visits (1.22, 95%CI 1.18 to 1.26) throughout follow-up. Within 1 year post-discharge, 717 (15.6%) KD cases were re-hospitalized, 4,587 (99.8%) had ≥1 outpatient physician visit and 1,695 (45.5%) had ≥1 ED visit. KD cases had higher composite health care costs post-discharge (e.g., median cost within 1 year: $2466 CAD [KD cases] versus $234 [comparators]). Total health care costs for KD cases, respectively, were $13.9 million within 1 year post-discharge and $54.8 million throughout follow-up (versus $2.2 million and $23.9 million for an equivalent number of comparators).
Conclusions:
Following diagnosis, KD cases had higher rates of health care utilization and costs versus nonexposed children. The rising incidence and costs associated with KD could place a significant burden on health care systems.
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