Cost analysis of pediatric intensive care: a low-middle income country perspective

Abstract

Background Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. In low middle-income countries, out of pocket expenditure (OOP) constitutes a major portion of the total expenditure. This makes it important to gain insights into the cost of pediatric intensive care. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during PICU stay. Methods Prospective study conducted in a state of the art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January to December 2018. Data regarding OOP was collected from 299 patients admitted from July 2017 to December 2018. The latter period was divided into four intervals, each of four and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient’s perspective. Results The median (inter-quartile range, IQR) length of PICU stay was 5(3–8) days. Mean ± SD Pediatric Risk of Mortality Score (PRISM III) score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non- ventilated child. Conclusions The fixed cost of PICU care was 3.8 times more than variable costs. Major portion of cost was borne by the hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary level intensive care in a public sector teaching hospital in India is far less expensive than developed countries.

Rare Medico Legal Cases of Pediatric Intensive Care Unit

“…Ariwala and colleagues reported an annual cost of treating child FBA cases of nearly $12.8 million (23). Additionally, the average cost of treating a patient in a PICU was estimated at approximately US$2100 in India (24). It's worth noting that treatment in the PICU is often more expensive, nearly four-fold, compared to treatment in a regular ward (24).…”

Sepsis in Children in Latin America

“…Pediatric sepsis is an important cause of mortality in children admitted to the pediatric intensive care unit (PICU). It is increasing in incidence and increasing the mortality and costs in the health care system, making it a worldwide public health problem 12 . Despite its being a topic of main concern, there is still little data on global prevalence and mortality about it and even less epidemiologic information available 13 .…”

“…It is increasing in incidence and increasing the mortality and costs in the health care system, making it a worldwide public health problem. 12 Despite its being a topic of main concern, there is still little data on global prevalence and mortality about it and even less epidemiologic information available. 13 The different definitions of sepsis do not allow uniformity in records.…”

Factors influencing the length of stay among patients admitted to a tertiary pediatric intensive care unit in Saudi Arabia

“…This study examined multiple variables contributing to the LOS. Previous studies identified several factors that contribute to the LOS including patient age, severity of illness, presence of nosocomial infections, acute kidney injury, cardiorespiratory disease, post-cardiac intervention patients, and patients with cardiac arrest before admission (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Complications related to clinical conditions, such as drugdrug interactions and hospital-acquired infections (HAIs), are also associated with prolonged LOS (10,14).…”