加纳一家教学医院因新生儿血流感染导致的成本及额外住院时间
Costs and Extra Length of Stay because of Neonatal Bloodstream Infection at a Teaching Hospital in Ghana.
作者信息
Fenny Ama Pokuaa, Otieku Evans, Labi Kwaku Appiah-Korang, Asante Felix Ankomah, Enemark Ulrika
机构信息
Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, PO Box LG 74, Accra, Ghana.
Department of Medical Microbiology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
出版信息
Pharmacoecon Open. 2021 Mar;5(1):111-120. doi: 10.1007/s41669-020-00230-x.
BACKGROUND
There are no published studies on the costs of hospital-acquired neonatal bloodstream infection (BSI) in Ghana. Therefore, this study aims to calculate the cost and extra length of stay (LOS) of neonatal BSI. A prospective case-control study was undertaken at the neonatal intensive care unit (NICU) of Korle Bu Teaching Hospital (KBTH) in Ghana.
METHODS
The clinical data of 357 neonates were prospectively analysed. Overall, 100 neonates with BSI and 100 control neonates without BSI were matched by weight, sex and type of delivery. The direct and indirect costs to neonates and their caregivers was obtained on a daily basis. The cost of drugs was confirmed with the Pharmacy Department at KBTH. A count data model, specifically negative binomial regression, was employed to estimate the extra LOS in the NICU due to neonatal BSI. The study analyzed the total, average and marginal costs of neonatal BSI for the case and control groups from the perspective of the patients/carers/providers.
RESULTS
Fifty-four percent of the total sample were born with a low birth weight. Neonates with BSI recorded higher costs compared with neonates without BSI. The highest difference in direct costs was recorded among neonates with extremely low birth weight (US$732), which is 67% higher than similar neonates without BSI. The regression estimates show a significant correlation between neonatal BSI and LOS in the NICU (p < 0.001). Neonates with BSI stayed an additional 10 days in the NICU compared with their matched cohort. The LOS varies significantly depending on the neonate's weight at birth. The extra days range from 1 day for neonates defined as macrosomia to 15 extra days for extremely low birth weight neonates.
CONCLUSIONS
Neonatal BSI was significantly associated with prolonged LOS. The continuous presence of experienced medical staff, as well as parents, to monitor newborns during their stay on the ward has enormous economic burden on both hospitals and caregivers.
背景
加纳尚无关于医院获得性新生儿血流感染（BSI）成本的已发表研究。因此，本研究旨在计算新生儿BSI的成本和额外住院时间（LOS）。在加纳科勒布教学医院（KBTH）的新生儿重症监护病房（NICU）进行了一项前瞻性病例对照研究。
方法
对357例新生儿的临床数据进行前瞻性分析。总体而言，100例有BSI的新生儿和100例无BSI的对照新生儿按体重、性别和分娩方式进行匹配。每天获取新生儿及其照料者的直接和间接成本。药物成本经KBTH药房确认。采用计数数据模型，特别是负二项回归，来估计新生儿BSI导致的NICU额外住院时间。该研究从患者/照料者/提供者的角度分析了病例组和对照组新生儿BSI的总成本、平均成本和边际成本。
结果
总样本中有54%为低出生体重儿。有BSI的新生儿的成本高于无BSI的新生儿。极低出生体重儿的直接成本差异最大（732美元），比无BSI的类似新生儿高67%。回归估计显示新生儿BSI与NICU住院时间之间存在显著相关性（p<0.001）。与匹配队列相比，有BSI的新生儿在NICU多住了10天。住院时间因新生儿出生时的体重而异。额外住院天数从巨大儿的1天到极低出生体重儿的15天不等。
结论
新生儿BSI与住院时间延长显著相关。经验丰富的医护人员以及父母在新生儿住院期间持续进行监测，给医院和照料者都带来了巨大的经济负担。
Zotero 插件