Spencer Ariel U, Kovacevich Debra, McKinney-Barnett Michelle, Hair Deanna, Canham Julie, Maksym Christopher, Teitelbaum Daniel H
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Am J Clin Nutr. 2008 Dec;88(6):1552-9. doi: 10.3945/ajcn.2008.26007.
Little information is available about the financial charges incurred by patients with short-bowel syndrome (SBS). This is particularly true for pediatric SBS patients who receive some of the most complex medical care.
The aims of this study were to determine the total cost of care for these patients and to analyze their utilization of home and hospital-based health care services.
This was a retrospective review of the total charges incurred by 41 children with SBS over the past decade, encompassing both inpatient and home-care charges.
The mean (+/- SD) total cost of care for pediatric SBS was US$505 250 +/- US$248 398 (corrected for inflation to the year 2005) for the first year of care alone. Inpatient hospitalization accounted for most of these expenses (US$416 818 +/- US$242 689, or 82% of the total), and this was attributable to prolonged requirements for intensive care resources, numerous surgical procedures, and multiple readmissions during the first year of diagnosis. Hospital-based costs steadily declined in subsequent years, but home-care services, in stark contrast, unexpectedly increased every year for the first 5 y of diagnosis-a trend that was highly significant (P < 0.005), reaching US$184 520 +/- US$111 075 for the fifth year of home care. This increasing cost was attributable to increasing complications of parenteral nutrition, especially infectious complications. Although per-patient charges varied widely, the mean total cost of care per child over a 5-y period was US$1 619 851 +/- US$1 028 985. A strong correlation was found between higher charges and infants with <10% of predicted small-bowel length.
This study was the first to calculate the total costs for pediatric SBS patients and to provide an in-depth analysis of these patients' actual utilization of health care services. This information may help guide health care providers and families who have children with SBS. The comprehensive care of pediatric SBS patients costs significantly more than has previously been estimated. Contrary to previous views, home care significantly increases each year after diagnosis.
关于短肠综合征（SBS）患者所产生的财务费用，现有信息较少。对于接受一些最复杂医疗护理的儿科SBS患者而言尤其如此。
本研究的目的是确定这些患者的总护理成本，并分析他们对家庭和医院医疗服务的利用情况。
这是一项对41例SBS患儿在过去十年中产生的总费用进行的回顾性研究，涵盖住院和家庭护理费用。
仅在护理的第一年，儿科SBS的平均（±标准差）总护理成本为505,250美元±248,398美元（已根据通货膨胀率校正至2005年）。住院费用占这些费用的大部分（416,818美元±242,689美元，占总数的82%），这归因于在诊断后的第一年对重症监护资源的长期需求、众多的外科手术以及多次再次入院。随后几年基于医院的成本稳步下降，但与之形成鲜明对比的是，家庭护理服务在诊断后的前5年每年意外增加——这一趋势非常显著（P < 0.005），在家庭护理的第五年达到184,520美元±111,075美元。成本增加归因于肠外营养并发症的增加，尤其是感染性并发症。尽管每位患者的费用差异很大，但每个孩子在5年期间的平均总护理成本为1,619,851美元±1,028,985美元。发现费用较高与预测小肠长度小于10%的婴儿之间存在强烈相关性。
本研究首次计算了儿科SBS患者的总成本，并对这些患者实际利用医疗服务的情况进行了深入分析。这些信息可能有助于指导照顾患有SBS儿童的医疗服务提供者和家庭。儿科SBS患者的综合护理成本明显高于先前估计。与先前观点相反，诊断后家庭护理每年显著增加。
