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J Glob Health. 2016 Jun;6(1):010408. doi: 10.7189/jogh.06.010408.

Cost of management of severe pneumonia in young children: systematic analysis.

Author information

1
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, PR China.
2
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
3
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; NHS Grampian, UK.
4
Department of Community Health, Federal University of Goias, Brazil.
5
Department of Community Health, Federal University of Goias, Brazil; State University of Maranhăo, Brazil.
6
New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA.
7
Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
8
National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia.
9
Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
10
Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
11
Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina.
12
Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh.
13
Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh; Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
14
Agence de Médicine Préventive, Paris, France.
15
Faculty of Public Health, University of Indonesia, Jakarta, Indonesia.
16
Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA.
17
Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
18
Pharmacy Department, Children's Hospital Colorado, Aurora, CO, USA.
19
Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
20
Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan.
21
James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
22
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India.

Abstract

BACKGROUND:

Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.

METHODS:

We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non-severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate.

RESULTS:

We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low- and-middle income countries (LMIC) and high-income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5-8.7), US$ 51.7 (95% CI 17.4-91.0) and US$ 242.7 (95% CI 153.6-341.4)-559.4 (95% CI 268.9-886.3) in community, out-patient facilities and different levels of hospital in-patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%-115.8% of patients' monthly household income in LMIC. The mean direct non-medical cost and indirect cost for severe pneumonia management accounted for 0.5-31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3-6.4) and 7.7 (IQR 5.5-9.9) days in LMIC and HIC respectively for these children.

CONCLUSION:

This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.

PMID:
27231544
PMCID:
PMC4871066
DOI:
10.7189/jogh.06.010408
[Indexed for MEDLINE]
Free PMC Article

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