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Methods to Reduce Cost of Treatment in Childhood Bone and Joint Infection: A Systematic Review
Sarah Hunter1,2, Haemish Crawford1,2, Braden Te Ao1,3
1University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.
Insights
Childhood bone and joint infections (BJI) incur rising hospital costs. Simplifying treatment with early imaging and oral antibiotics can lower expenses and improve outcomes for pediatric BJI patients.
Area of Science:
- Pediatric Infectious Diseases
- Health Economics
- Clinical Management
Background:
- Childhood bone and joint infections (BJI) pose significant health risks and financial burdens.
- Optimizing treatment is crucial due to rising healthcare costs and caregiver impact.
Approach:
- Systematic literature review (1980-2024) of pediatric BJI hospitalization costs and cost-reduction strategies.
- Data analyzed for cost per day (USD, 2023 parity) by decade and region.
- Focused on innovations reducing length of stay (LOS) and treatment complexity.
Key Points:
- Hospitalization costs for pediatric BJI have risen significantly since the 1990s.
- Average length of stay (LOS) appears to be decreasing.
- Higher costs observed in the US and for methicillin-resistant Staphylococcus aureus cases.
Conclusions:
- Simplifying pediatric BJI treatment can mitigate rising hospital costs and economic impact on families.
- Protocols incorporating early advanced imaging and oral antibiotic switch show promise for cost reduction with satisfactory outcomes.
Background:
Childhood bone and joint infection (BJI) is a potentially severe disease with consequences for growth and development. Critically unwell children may require prolonged hospitalization and multiple surgeries. Acknowledging rising healthcare costs and the financial impact of illness on caregivers, increased efforts are required to optimize treatment. This systematic review aims to characterize existing costs of hospital care and summarize strategies, which reduce treatment expense.
Methods:
A systematic review of the literature was performed from January 1, 1980, to January 31, 2024. Data were extracted on hospitalization costs for pediatric BJI by decade and global region. Results have been converted to cost per day in US dollars with purchase parity for 2023. Studies reporting innovations in clinical care to reduce length of stay (LOS) and simplify treatment were identified. Studies trialing shorter antibiotic treatment were only included if they specifically reported changes in LOS.
Results:
Twenty-three studies met inclusion criteria; of these, a daily hospitalization cost could be derived from 7 publications. Overall hospitalization cost and inpatient charges rose steeply from the 1990s to the 2020s. By contrast, average LOS seems to have decreased. Cost per day was higher in the United States than in Europe and higher for cases with confirmed methicillin-resistant Staphylococcus aureus. Sixteen studies report innovations to optimize care. For studies where reduced LOS was achieved, early magnetic resonance imaging with immediate transfer to theater when necessary and discharge on oral antibiotics were consistent features.
Conclusion:
Rising costs of hospital care and economic consequences for families can be mitigated by simplifying treatment for childhood BJI. Hospitals that adopt protocols for early advanced imaging and oral antibiotic switch may provide satisfactory clinical outcomes at lower cost.
Level Of Evidence:
Level III. See Instructions for Authors for a complete description of levels of evidence.
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