Health Care Improvement Project, United States Agency for International Development, University Research Co., LLC, Bethesda, Maryland, United States of America.
Rev Panam Salud Publica. 2011 Nov;30(5):453-60.
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.
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.
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).
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.
根据支出数据和影响指标，确定在尼加拉瓜 14 家医院实施改善儿童腹泻或肺炎治疗质量的干预措施的成本和成本效益。
从参与的 14 家医院中的 7 家医院的随机样本中提取 1294 份临床记录的住院时间（LOS）和死亡人数，这些记录在干预前（2003 年）完成，然后在干预实施两年后（2006 年）完成 1505 份记录。从结果数据中得出残疾调整生命年（DALY）。根据医院和卫生部的记录以及私营部门的数据计算住院费用。干预费用来自项目会计记录。采用决策树分析计算增量成本效益。
腹泻的平均 LOS 分别从干预前的 3.87 天和 4.23 天减少到干预后的 3.55 天和 3.94 天（P=0.078），肺炎的平均 LOS 分别从干预前的 3.87 天和 4.23 天减少到干预后的 3.55 天和 3.94 天（P=0.055）。腹泻的病例死亡率从干预前的 45/10000 和 34/10000 分别下降到干预后的 30/10000 和 27/10000（P=0.062），肺炎的病例死亡率从干预前的 45/10000 和 34/10000 分别下降到干预后的 30/10000 和 27/10000（P=0.37）。两种诊断的平均总住院和抗生素费用分别为干预前的 451 美元（95%置信区间[CI]：419 美元-482 美元）和干预后的 437 美元（95% CI：402 美元-464 美元）。从 DALY 角度看，该干预措施具有成本效益（95%CI：-522 美元至 32 美元/每避免 1 个 DALY），且避免 1 天住院治疗的成本为 21 美元（95%CI：-45 美元至 204 美元）。
在干预实施两年后，腹泻的 LOS 和死亡人数下降，肺炎的 LOS 也有所下降，住院费用没有增加。如果这些变化完全归因于干预措施，那么它将具有成本效益。
