Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective

• Published in: Archives of disease in childhood Vol. 109; no. 8; p. 622
• Main Authors: Sultana, Marufa, Watts, Jennifer J, Alam, Nur H, Faruque, A S G, Fuchs, George J, Gyr, Niklaus, Ali, Nausad, Chisti, Md Jobayer, Ahmed, Tahmeed, Abimanyi-Ochom, Julie, Gold, Lisa
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.08.2024
• Subjects: Attrition (Research Studies); Bangladesh; Caregivers; Child, Preschool; Children; Costs; Data Analysis; Evidence; Expenditures; Female; Health care; Health Care Costs - statistics & numerical data; Health facilities; Health Services; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitals; Households; Humans; Infant; Interviews; Length of stay; Length of Stay - economics; Length of Stay - statistics & numerical data; Low Income; Low income groups; Male; Malnutrition; Mortality; Nutrition; Patients; Pneumonia; Pneumonia - economics; Pneumonia - therapy; Public health; Questionnaires; Regression (Statistics); Regression analysis; Rural areas; Sensitivity analysis; Social Development; Statistical Significance; Unit Costs; Urban areas; Bangladesh; United States > US; Health Care Economics and Organizations; Child Health Services; Child Health; Health services research
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2022-325222

To estimate inpatient care costs of childhood severe pneumonia and its urban-rural cost variation, and to predict cost drivers. The study was nested within a cluster randomised trial of childhood severe pneumonia management. Cost per episode of severe pneumonia was estimated from a healthcare provider perspective for children who received care from public inpatient facilities. A bottom-up micro-costing approach was applied and data collected using structured questionnaire and review of the patient record. Multivariate regression analysis determined cost predictors and sensitivity analysis explored robustness of cost parameters. Eight public inpatient care facilities from two districts of Bangladesh covering urban and rural areas. Children aged 2-59 months with WHO-classified severe pneumonia. Data on 1252 enrolled children were analysed; 795 (64%) were male, 787 (63%) were infants and 59% from urban areas. Average length of stay (LoS) was 4.8 days (SD ±2.5) and mean cost per patient was US$48 (95% CI: US$46, US$49). Mean cost per patient was significantly greater for urban tertiary-level facilities compared with rural primary-secondary facilities (mean difference US$43; 95% CI: US$40, US$45). No cost variation was found relative to age, sex, malnutrition or hypoxaemia. Type of facility was the most important cost predictor. LoS and personnel costs were the most sensitive cost parameters. Healthcare provider cost of childhood severe pneumonia was substantial for urban located public health facilities that provided tertiary-level care. Thus, treatment availability at a lower-level facility at a rural location may help to reduce overall treatment costs.