Direct medical costs in management of preterm neonates with respiratory distress syndrome in an Indian tertiary care teaching hospital

Abstract

Objectives To determine the direct medical costs in management of preterm neonates with respiratory distress syndrome and study its variations in different gestational age. Methods Prospective observational study was conducted in an Indian tertiary care teaching hospital NICU during a period of 10 months (August 2015 to June 2016) on neonates with neonatal respiratory distress syndrome. Preterm neonates were grouped according to gestational ages: very preterm (28–31 weeks + 6 days) and moderate-late preterm (32–36 weeks + 6 days) to identify differences in the utilisation of resources and cost. The attributes included in the Direct Medical Cost (DMC) were bed charges in NICU and general ward, laboratory and diagnostics, expense over drugs and exogenous surfactants, MV and equipment, surgical procedures, other inpatient department charges which involves indoor registration charges, consultation charges, hospital drugs and materials. Finally, the costs were expressed in USD. Key findings Forty-eight preterm neonates were included in this study. The average DMC per patient with RDS was 1329USD while it is found to be higher in very preterm 1464 USD and 1058 USD in moderate-late preterm group. The DMC per day incurred by the patient caregivers was 40.7 USD, out of which two-third of the expenditure was from NICU (26 USD). The highest percentage of expenditure from all resources was with bed charges 42% (27 054 USD). These results indicate that the management of RDS require more cost and the highest cost burden was seen in very preterm gestational age group. Conclusions The total DMC in preterm neonates with RDS presents important fluctuations (73–27%) within the two groups, because of the use of medical resources is relative to gestational age, birthweight and clinical conditions of patients during hospitalisation. The direct cost implication is huge in very preterm neonates.