Abstract
BackgroundInvasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown.AimTo determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective.MethodsA cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children’s Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed.ResultsOf the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0–4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11–2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0–4 years (62%).ConclusionAs these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted.Trial registrationThe current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.
Highlights
Invasive Group A Streptococcal disease exerts an important burden among Australian children
The minimum annual healthcare cost for children hospitalised with Invasive Group A Streptococcal (iGAS) disease at Royal Children’s Hospital (RCH) Sixty-five patients with iGAS disease were admitted to RCH and included in the analyses
Resources and costs The estimated average iGAS disease-related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute readmissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively)
Summary
Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown. Invasive Group A Streptococcal (iGAS) disease is a serious condition that occurs when GAS infects a normally sterile body site. In the United States, the annual cost associated with all GAS pharyngitis disease in children was estimated between $284 and $684 million 2019 USD (CPI https://www.bls.gov/data/ inflation_calculator.htm; $224 and $539 million; 2006 USD), with just over half this sum as direct healthcare costs and the remainder as indirect costs, including lost productivity through parental time off work [5]. In New Zealand, the annual direct healthcare costs associated with all GAS disease across children and adults was estimated at $46 million 2019 USD In New Zealand, the annual direct healthcare costs associated with all GAS disease across children and adults was estimated at $46 million 2019 USD (CPI https://www.bls. gov/data/inflation_calculator.htm and purchasing power parities (PPP) https://data.oecd.org/conversion/ purchasing-power-parities-ppp.htm#indicator-chart; $30 million; 2015 NZD) [6]
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