Abstract
ABSTRACTObjective To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective.Methods Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test.Results Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (p<0.001) or record review (p=0.006).Conclusion Brazilian Public Unified Health System costs estimated via different costing methods differ significantly, with gross-costing yielding lower cost estimates. Given costs estimated by different micro-costing methods are similar and costing methods based on therapeutic guidelines are easier to apply and less expensive, this method may be a valuable alternative for estimation of hospitalization costs of bacterial community-acquired pneumonia in children.
Highlights
Pneumonia is a significant cause of morbidity and mortality all over the world
In 2010, an estimated 120 million new episodes of the disease affected children aged under 5 years, with 935 thousand cases progressing to death worldwide.[1]. In Latin America, 980 thousand to 1.5 million cases of pneumonia are estimated to occur in children aged under 5 years each year.[2,3,4] Brazil is one of the countries with high incidence of pneumonia worldwide.[5]
Study population and sample The study population comprised children aged between 28 days and 35 months hospitalized due to community-acquired pneumonia (CAP), and enrolled in a prospective population-based pneumonia surveillance study conducted in 17 child hospitals in the city of Goiânia (GO).(8) This costing study was based on a sample of children admitted to two of these hospitals, totaling up 111 clinical beds and 38 pediatric intensive care unit (ICU) beds, accounting to approximately 30% of children hospitalized due to CAP, in a prospective population-based design
Summary
In 2010, an estimated 120 million new episodes of the disease affected children aged under 5 years, with 935 thousand cases progressing to death worldwide.[1] In Latin America, 980 thousand to 1.5 million cases of pneumonia are estimated to occur in children aged under 5 years each year.[2,3,4] Brazil is one of the countries with high incidence of pneumonia worldwide.[5]. Estimated costs of inpatient treatment of pneumonia in children aged less than 5 years in Latin America range from US$ 804.46 to US$ 1,076.89.(2,6) Several costing methods with different levels of accuracy and quality may be applied to estimate disease costs, bottom-up micro-costing, top-down micro-costing and gross-costing being the most common.[7]. Given the variability of results across costing methods, estimation of Brazilian costs of inpatient cases of severe pneumonia in children via different methods is of particular relevance
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