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Cost of Pediatric Pneumonia Episodes With or Without Chest Radiography
Alexandra T Geanacopoulos1,2, Mark I Neuman1,2, Kenneth A Michelson3
1Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Insights
Chest X-rays (CXRs) for pediatric community-acquired pneumonia (CAP) in the emergency department (ED) are cost-effective. CXR use in children with CAP leads to significant 28-day cost savings, primarily from reduced subsequent healthcare visits.
Area of Science:
- Pediatric Emergency Medicine
- Health Economics
- Diagnostic Imaging
Background:
- Community-acquired pneumonia (CAP) is common in children presenting to emergency departments (EDs).
- The cost-effectiveness of routine chest radiography (CXR) for diagnosing CAP in pediatric EDs remains uncertain.
- Assessing the economic impact of CXR in pediatric CAP workups is crucial for resource allocation.
Purpose of the Study:
- To evaluate the cost-effectiveness of using chest radiography (CXR) in the workup of community-acquired pneumonia (CAP) among children discharged from the pediatric emergency department (ED).
- To analyze the total 28-day healthcare costs associated with CAP episodes, comparing those with and without CXR.
Main Methods:
- Retrospective cohort study utilizing the Healthcare Cost and Utilization Project State ED and Inpatient Databases (2014-2019).
- Inclusion of children aged 3 months to 18 years diagnosed with CAP and discharged from EDs in 8 states.
- Analysis of 28-day total costs post-ED discharge, including index visit and subsequent care, using mixed-effects linear regression adjusted for patient factors and illness severity.
Main Results:
- A total of 225,781 children with CAP were evaluated; 86.2% received a CXR during their index ED visit.
- The median 28-day cost per episode was $314. Patients receiving a CXR incurred $33 less in total 28-day costs compared to those without CXR (95% CI: $22-$44).
- Savings were predominantly observed in subsequent healthcare visits ($26 savings) rather than the index ED visit ($6 savings).
Conclusions:
- Chest radiography (CXR) for diagnosing community-acquired pneumonia (CAP) in pediatric emergency departments (EDs) is associated with lower overall healthcare costs.
- The cost-effectiveness of CXR is driven by reduced downstream healthcare utilization and costs for subsequent care.
- Routine CXR in pediatric CAP evaluations can be a cost-saving strategy when considering the full episode of care.
Background And Objectives:
Despite its routine use, it is unclear whether chest radiograph (CXR) is a cost-effective strategy in the workup of community-acquired pneumonia (CAP) in the pediatric emergency department (ED). We sought to assess the costs of CAP episodes with and without CXR among children discharged from the ED.
Methods:
This was a retrospective cohort study within the Healthcare Cost and Utilization Project State ED and Inpatient Databases of children aged 3 months to 18 years with CAP discharged from any EDs in 8 states from 2014 to 2019. We evaluated total 28-day costs after ED discharge, including the index visit and subsequent care. Mixed-effects linear regression models adjusted for patient-level variables and illness severity were performed to evaluate the association between CXR and costs.
Results:
We evaluated 225c781 children with CAP, and 86.2% had CXR at the index ED visit. Median costs of the 28-day episodes, index ED visits, and subsequent visits were $314 (interquartile range [IQR] 208-497), $288 (IQR 195-433), and $255 (IQR 133-637), respectively. There was a $33 (95% confidence interval [CI] 22-44) savings over 28-days per patient for those who received a CXR compared with no CXR after adjusting for patient-level variables and illness severity. Costs during subsequent visits ($26 savings, 95% CI 16-36) accounted for the majority of the savings as compared with the index ED visit ($6, 95% CI 3-10).
Conclusions:
Performance of CXR for CAP diagnosis is associated with lower costs when considering the downstream provision of care among patients who require subsequent health care after initial ED discharge.
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