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Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis
Jinghan Zhang1, Palmila Liu1, Ajay M Narayanan1
1Department of Otolaryngology-Head and Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA.
Insights
Pediatric tracheostomy care costs exceed $300 million, with inpatient stays driving 96% of expenses. Minimizing hospital admissions is key to reducing direct health expenditures for these children.
Area of Science:
- Pediatric Healthcare Economics
- Tracheostomy Management
- Health Services Research
Background:
- Pediatric tracheostomy is a critical intervention for children with complex respiratory needs.
- The direct costs associated with long-term pediatric tracheostomy care are substantial but not fully characterized.
Purpose of the Study:
- To determine the direct financial costs of pediatric tracheostomy care within a large healthcare system.
- To identify key cost drivers and factors influencing healthcare expenditures for this patient population.
Main Methods:
- Prospective analysis of direct costs for pediatric tracheostomy patients (under 18) from 2015-2021.
- Utilized Medicare/Medicaid charges-to-costs ratio for visit types and generalized linear equations for cost estimation.
- Accounted for confounders to analyze cost drivers such as length of stay and readmissions.
Main Results:
- Total direct costs reached $321 million over the study period.
- Initial admissions (72%) and subsequent inpatient stays (24%) constituted 96% of total costs.
- Length of stay was a primary driver, with each additional day costing ~$1195 and each readmission ~$130,223.
Conclusions:
- Pediatric tracheostomy care represents a significant financial burden, exceeding $300 million in direct costs over five years.
- Inpatient utilization, particularly length of stay, is the predominant factor in healthcare expenditures.
- Strategies focused on reducing hospital admissions are crucial for mitigating direct health costs in pediatric tracheostomy patients.
Objective:
This study aimed to determine the direct costs of pediatric tracheostomy care within a health care system.
Study Design:
Prospective analysis.
Setting:
Academic children's hospital.
Methods:
Costs associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges-to-costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders.
Results:
A total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow-up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions.
Conclusion:
Pediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOS being a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.
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