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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amrit Kaur ◽  
Muralidharan Jayashree ◽  
Shankar Prinja ◽  
Ranjana Singh ◽  
Arun K. Baranwal
Keyword(s):  
Intensive Care ◽  
Health System ◽  
Pediatric Intensive Care ◽  
Major Portion ◽  
Severe Illness ◽  
Tertiary Level ◽  
Middle Income ◽  
System Cost ◽  
Health System Cost ◽  
Low Middle Income Countries

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.

scholarly journals Cost Analysis of Pediatric Intensive Care: A Low-Middle Income Country Perspective

2020 ◽  
Author(s):  
Amrit Kaur ◽  
Muralidharan Jayashree ◽  
Shankar Prinja ◽  
Ranjana Singh ◽  
Arun K. Baranwal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health System ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Severe Illness ◽  
Annual Data ◽  
System Cost ◽  
Health System Cost ◽  
State Of Art

Abstract Background: Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. This makes it important to gain insights into the cost of pediatric intensive care units. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during Pediatric Intensive Care Unit (PICU) stayMethods: Prospective study conducted in a state of 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 2018 to December 2018. Data regarding out of pocket expenditure (OOP) was collected from 299 patients who were admitted from July 2017 to December 2018. The study period was divided into four intervals, each of 4 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 PRISM 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$ 2,078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1,731 (₹ 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 were 3.5 times more than variable costs. Major portion of cost is borne by 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 care state of art intensive care in a public sector teaching hospital in India is far less expensive than developed countries.

scholarly journals Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

2021 ◽  
Vol 6 (5) ◽  
pp. e004324
Author(s):  
John Whitaker ◽  
Nollaig O'Donohoe ◽  
Max Denning ◽  
Dan Poenaru ◽  
Elena Guadagno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Evidence Synthesis ◽  
Rapid Assessment ◽  
Sub Saharan Africa ◽  
Trauma Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Three Delays

BackgroundThe large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.MethodsWe conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.ResultsOf 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.ConclusionsWhole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.

scholarly journals Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Dzulfikar D. L. Hakim ◽  
Ahmad Faried ◽  
Adila Nurhadiya ◽  
Ericko H. Laymena ◽  
Muhammad Z. Arifin ◽  
...  
Keyword(s):  
Rare Case ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Pediatric Intensive Care ◽  
Toxin Production ◽  
Clostridium Tetani ◽  
Anesthetic Care ◽  
Middle Income ◽  
Depressed Skull Fracture ◽  
Low Middle Income Countries

Abstract Background Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. Case presentation We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed. Conclusion The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

scholarly journals Predictors of mortality in children with acute kidney injury in intensive care unit

2019 ◽  
Vol 59 (2) ◽  
pp. 92-7
Author(s):  
Umi Rakhmawati ◽  
Indah K. Murni ◽  
Desy Rusmawatiningtyas
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Protective Factor ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
P Value ◽  
Middle Income ◽  
Predictors Of Mortality ◽  
Middle Income Countries

Background Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia. Objective To assess possible predictors of mortality in children with AKI in the PICU. Methods We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors. Results Of the 152 children with AKI recruited, 119 died. In order to get a P value of <0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P<0.001), 8.6 (95%CI 2.7 to 27.6; P<0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively. Conclusion The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients. 

scholarly journals Implementing standard antenatal care interventions: health system cost at primary health facilities in Tanzania

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Amisa Tindamanyile Chamani ◽  
Amani Thomas Mori ◽  
Bjarne Robberstad
Keyword(s):  
Standard Model ◽  
Antenatal Care ◽  
Health System ◽  
Health Facilities ◽  
System Cost ◽  
Primary Health ◽  
Health System Cost ◽  
The Standard Model ◽  
Health Centres ◽  
Primary Health Facilities

Abstract Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system are unknown, particularly in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Costs were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services at six facilities (2 health centres and 4 dispensaries) was US$185,282 under the focused model. We estimated that the cost would increase by about 90% at health centres and 97% at dispensaries to US$358,290 by introducing the standard model. Personnel cost accounted for more than one third of the total cost, and more than two additional nurses are required per facility for the standard model. The costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries. Conclusion Introduction of a standard ANC model at primary health facilities in Tanzania may double resources requirement compared to current practice. Resources availability has been one of the challenges to effective implementation of the current focused ANC model. More research is required, to consider whether the additional costs are reasonable compared to the additional value for maternal and child health.

scholarly journals Health System Cost of Post-Abortion Care (PAC): A Systematic Review

2021 ◽  
Author(s):  
Estro Dariatno Sihaloho ◽  
Ibnu Habibie ◽  
Fariza Zahra Kamilah ◽  
Yodi Christiani
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Direct Cost ◽  
Medical Cost ◽  
Cochrane Library ◽  
System Cost ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Health System Cost ◽  
Post Abortion

Abstract Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

scholarly journals Implementing Standard Antenatal Care Interventions: Health System Cost at Primary Health Facilities in Tanzania.

2021 ◽  
Author(s):  
Amisa Tindamanyile Chamani ◽  
Amani Thomas Mori ◽  
Bjarne Robberstad
Keyword(s):  
Standard Model ◽  
Antenatal Care ◽  
Health System ◽  
Health Facilities ◽  
System Cost ◽  
Primary Health ◽  
Health System Cost ◽  
The Standard Model ◽  
Health Centres ◽  
Primary Health Facilities

Abstract Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system is unknown, particulary in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Cost were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services was US$185,282 under the focused model and the cost increased by about 90% at health centres and 97% at dispensaries to US$358,290 for the standard model. Personnel cost accounted for more than one third of the total cost for both models. With the standard model, costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries Conclusion Introduction of a standard ANC model at primary healthcare facilities in Tanzania will double resources use compared to current practice. While resources availability has been one of the challenge to effective implementation of the focused ANC model, more research is required, to consider whether these costs are reasonable compared to the additional value for maternal and child health.

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