SciELO - Scientific Electronic Library Online

 
vol.30 issue5Clinical trial regulation in Argentina: overview and analysis of regulatory framework, use of existing tools, and researchers' perspectives to identify potential barriersAntidepressant prescription patterns in patients affiliated with the General Social Security Health System of Colombia author indexsubject indexarticles search
Home Page  

Revista Panamericana de Salud Pública

Print version ISSN 1020-4989

Abstract

BROUGHTON, Edward I; GOMEZ, Ivonne; NUNEZ, Oscar  and  WONG, Yudy. Cost-effectiveness of improving pediatric hospital care in Nicaragua. Rev Panam Salud Publica [online]. 2011, vol.30, n.5, pp. 453-460. ISSN 1020-4989.  http://dx.doi.org/10.1590/S1020-49892011001100008.

OBJECTIVE: To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. METHODS: Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. RESULTS: Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204). CONCLUSIONS: After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

Keywords : Hospital costs; hospitals, pediatric; cost-benefit analysis; diarrhea; pneumonia; delivery of health care; Nicaragua.

        · abstract in Spanish     · text in English     · pdf in English