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Resource Utilization and Cost Analysis of Pediatric Esophageal Foreign Bodies
Tanya Chen1, Jennifer M Siu1, Yasmine Madan1
1Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Insights
Pediatric esophageal foreign bodies (EFBs) incur significant healthcare costs, primarily due to transfers, delayed consultations, and high-risk items like button batteries. Improving prevention and local management can reduce this economic burden.
Area of Science:
- Pediatric Gastroenterology
- Health Economics
- Otolaryngology
Background:
- Impacted esophageal foreign bodies (EFBs) are a common pediatric emergency requiring esophagoscopy.
- These presentations are largely preventable, highlighting the need for targeted interventions.
Purpose of the Study:
- To quantify the overall economic impact of pediatric EFBs.
- To identify key factors contributing to increased healthcare resource utilization.
Main Methods:
- A cost analysis was conducted on pediatric patients undergoing esophagoscopy for EFB removal between 2010 and 2021.
- Direct and indirect healthcare costs were calculated using hospital and provincial fee data.
- Patient characteristics, EFB type, transfer status, and hospital course were analyzed.
Main Results:
- The total cost for pediatric EFBs from 2010-2021 was $2,673,288, averaging $3469 per child.
- Delays in Otolaryngology-Head and Neck Surgery (OHNS) consultation ($816/hour) and transfers to tertiary centers ($1965) significantly increased costs.
- Higher-risk EFBs, particularly button batteries (8.8x cost of coins), led to longer stays and higher complication rates, increasing overall costs by $4095.
Conclusions:
- Pediatric EFBs represent a substantial economic burden driven by inter-facility transfers, operational delays, and the nature of the foreign body.
- Enhanced parental education for primary prevention, timely OHNS team involvement, and improved community hospital capacity are crucial for mitigating costs.
Objective:
Impacted esophageal foreign bodies (EFBs) are a common but preventable presentation in children, requiring prompt removal in the operating room by esophagoscopy. Our objective was to describe the overall cost of impacted pediatric EFBs and determine factors that increase resource burden.
Methods:
A cost analysis of pediatric patients undergoing esophagoscopy for EFB removal from 2010 to 2021 was performed. Characteristics of each EFB, patient transfer, and hospital course were collected. Direct and indirect healthcare costs were calculated using hospital-specific costs and provincial fees. Amounts were calculated in Canadian dollars.
Results:
Six hundred and eighty patients were included. The total amount spent on pediatric EFBs from 2010 to 2021 was $2,673,288. The mean total cost per child with an EFB was $3469. An extra hour of delay before Otolaryngology-Head and Neck Surgery (OHNS) consultation at a tertiary hospital corresponded to an $816 cost [95% confidence interval (CI; 244.7-1287.4)]. On average, children requiring transfer to a tertiary care center cost $1965 more than those initially presenting to a tertiary care center (P = .001). Higher-risk EFBs (n = 165, 24%) were associated with a longer hospital stay and greater complication rate and resulted in a $4095 increase in overall cost compared to lower-risk EFBs [$6829 (standard deviation (SD) $11,347) vs $2734 (SD $10,451), P = .02]. Button battery ingestions cost 8.8 times more than non-dangerous EFBs, such as coins. Longer distance for transfer was associated with a higher likelihood of having complications [odds ratios (OR) 1.5, 95% CI (1.1-1.8)].
Conclusion:
EFBs pose a significant economic burden to the healthcare system, driven by transfer to a tertiary care center, delays in transfer to the operating room, and high-risk EFBs. It is critical to identify areas for improved efficiency such as increased parental education for primary prevention, early involvement of the OHNS team and improving the capacity of community hospitals to manage EFB to limit transfers when possible.
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