Direct medical costs of pediatric asthma exacerbations requiring hospital attendance in a middle-income country

C.E. Rodriguez-Martinez; M.P. Sossa-Briceno; J.A. Castro-Rodriguez

C.E. Rodriguez-Martinez

Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia.

M.P. Sossa-Briceno

Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.

J.A. Castro-Rodriguez

Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.

Keywords

Asthma attack, Direct cost items, Health economics, Hospitalization costs, Length of stay

Abstract

Introduction and objectives: With the aim of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating pediatric asthma exacerbations, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with pediatric asthma exacerbations requiring hospital attendance in Bogota, Colombia.

Patients and methods: We reviewed the available electronic medical records (EMRs) for all pediatric patients who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis pediatric asthma exacerbation over a 24-month period from January 2016 to December 2017. Direct medical costs of pediatric asthma exacerbations were retrospectively collected by dividing the patients into four groups: those admitted to the emergency department (ED) only; those admitted to the pediatric ward (PW); those admitted to the pediatric intermediate care unit (PIMC); and those admitted to the pediatric intensive care unit (PICU).

Results: A total of 252 patients with a median (IQR) age of 5.0 (3.0-7.0) years were analyzed, of whom 142 (56.3%) were males. Overall, the median (IQR) cost of patients treated in the ED, PW, PIMC, and PICU was US$38.8 (21.1-64.1) vs. US$260.5 (113.7-567.4) vs. 1212.4 (717.6-1609.6) vs. 2501.8 (1771.6-3405.0), respectively: this difference was statistically significant (p < 0.001).

Conclusions: The present study helps to further our understanding of the economic burden of pediatric asthma exacerbations requiring hospital attendance among pediatric patients in a MIC.

Abstract 63 | PDF Downloads 107

References

1. Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009;123 Suppl 3:S131-145.

2. Dennis RJ, Caraballo L, Garcia E, et al. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med. 2012;12:17.

3. Bahadori K, Doyle-Waters MM, Marra C, et al. Economic burden of asthma: a systematic review. BMC Pulm Med. 2009;9:24.

4. The Global Asthma Report 2018. Auckland, New Zealand: Global Asthma Network; 2018.

5. McCormick MC, Kass B, Elixhauser A, Thompson J, Simpson L. Annual report on access to and utilization of health care for children and youth in the United States–1999. Pediatrics. 2000;105 1 Pt 3:219-30.

6. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. New Engl J Med. 1992;326(13):862-6.

7. van Schayck OC. Global strategies for reducing the burden from asthma. Primary Care Respir J. 2013;22(2):239-43.

8. Rodriguez-Martinez CE, Sossa-Briceno MP, Castro-Rodriguez JA. Cost-effectiveness of pharmacological treatments for asthma: a systematic review. Pharmaco Econ. 2018;36(10): 1165-200.

9. Bavbek S, Mungan D, Turktas H, Misirligil Z, Gemicioglu B. A cost-of-illness study estimating the direct cost per asthma exacerbation in Turkey. Respir Med. 2011;105(4):541-8.

10. Ivanova JI, Bergman R, Birnbaum HG, Colice GL, Silverman RA, McLaurin K. Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. J Allergy Clin Immunol. 2012;129(5):1229-35.

11. Sullivan PW, Ghushchyan VH, Campbell JD, Globe G, Bender B, Magid DJ. Measuring the cost of poor asthma control and
exacerbations. J Asthma. 2017;54(1):24-31.

12. Zeiger RS, Schatz M, Dalal AA, et al. Utilization and costs of severe uncontrolled asthma in a managed-care setting. J Allergy Clin Immunol Pract. 2016;4(1):120-9.e123.

13. Dieleman JL, Squires E, Bui AL, et al. Factors associated with increases in US health care spending, 1996-2013. Jama. 2017;318(17):1668-78.

14. Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. Jama. 2018;319(10):1024-39.

15. Banco de la República, Colombia. Series estadísticas. Tasas de cambio. Santa Fe de Bogotá: Banco de la República; 2011. Available from: http://www.banrep.gov.co/series-estadisticas/see ts cam.htm. (last accessed 20 December 2018).

16. Gamba-Sanchez N, Rodriguez-Martinez CE, Sossa-Briceno MP. Epidemic activity of respiratory syncytial virus is related to temperature and rainfall in equatorial tropical countries. Epidemiol Infect. 2016;144(10):2057-63.

17. Banasiak NC, Meadows-Oliver M. Inpatient asthma clinical pathways for the pediatric patient: an integrative review of the literature. Pediatr Nurs. 2004;30(6):447-50.

18. Chen KH, Chen CC, Liu HE, Tzeng PC, Glasziou PP. Effectiveness of paediatric asthma clinical pathways: a narrative systematic
review. J Asthma. 2014;51(5):480-92.

19. Gellert GA, Davenport CM, Minard CG, Castano C, Bruner K, Hobbs D. Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry. J Asthma. 2019:1-13.

20. Celik GE, Bavbek S, Pasaoglu G, et al. Direct medical cost of asthma in Ankara, Turkey. Respir Int Rev Thorac Dis. 2004;71(6):587-93.

21. Oostenbrink JB, Rutten-van Molken MP. Resource use and risk factors in high-cost exacerbations of COPD. Respir Med. 2004;98(9):883-91.

22. Cisternas MG, Blanc PD, Yen IH, et al. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003;111(6):1212-8.

23. Jansson SA, Ronmark E, Forsberg B, Lofgren C, Lindberg A, Lundback B. The economic consequences of asthma among adults in Sweden. Respir Med. 2007;101(11):2263-70.

24. Rutten van-Molken MP, Feenstra TL. The burden of asthma and chronic obstructive pulmonary disease: data from The Netherlands. Pharmaco Econ. 2001;19 Suppl 2:1-6.

25. Stock S, Redaelli M, Luengen M, Wendland G, Civello D, Lauterbach KW. Asthma: prevalence and cost of illness. Eur Respir J. 2005;25(1):47-53.

26. Homedes N., Lopez Linares R., Ugalde A. Generic Drug Policies in Latin America. Available at: http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/HomedesGenericDrugFinal.pdf. (last accessed 20 December 2018).

27. Acosta A. Regulation of Prices of Medicines in South America: Results and Concrete Strategies of Colombia. Available at: http://isags-unasur.org/en/regulation-of-prices-of-medicinesin-south-america-results-and-concrete-strategies-of-colombia/.
(last accessed 20 December 2018).

28. García VM. Los medicamentos genéricos en Colombia: industria, políticas de salud y farmaceutización durante la década de 1960. Historia Crít. 2017;65:115-37.

29. Meurer JR, Kuhn EM, George V, Yauck JS, Layde PM. Charges for childhood asthma by hospital characteristics. Pediatrics.
1998;102(6): E70.

30. Himmelstein DU, Jun M, Busse R, et al. A comparison of hospital administrative costs in eight nations: US costs exceed all others by far. Health Affairs (Project Hope). 2014;33(9):1586-94.

PDF

Published

Mar 15, 2020

Issue

Vol. 48 No. 2 (2020): Allergologia et Immunopathologia

Section

Original Articles