Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH.
J Pediatr. 2021 Apr;231:94-101.e2. doi: 10.1016/j.jpeds.2020.10.033. Epub 2020 Oct 31.
To compare the medical costs associated with risk stratification criteria used to evaluate febrile infants 29-90 days of age.
A cost analysis study was conducted evaluating the Boston, Rochester, Philadelphia, Step-by-Step, and PECARN criteria. The percentage of infants considered low risk and rates of missed infections were obtained from published literature. Emergency department costs were estimated from the Centers for Medicare and Medicaid Services. The Health Care Cost and Utilization Project databases were used to estimate the number of infants ages 29-90 days presenting with fever annually and costs for admissions related to missed infections. A probabilistic Markov model with a Dirichlet prior was used to estimate the transition probability distributions for each outcome, and a gamma distribution was used to model costs. A Markov simulation estimated the distribution of expected annual costs per infant and total annual costs.
For low-risk infants, the mean cost per infant for the criteria were Rochester: $1050 (IQR $1004-$1092), Philadelphia: $1416 (IQR, $1365-$1465), Boston: $1460 (IQR, $1411-$1506), Step-by-Step $942 (IQR, $899-$981), and PECARN $1004 (IQR, $956-$1050). An estimated 18 522 febrile 1- to 3-month-old infants present annually and estimated total mean costs for their care by criteria were: Rochester, $127.3 million (IQR, $126.1-$128.5); Philadelphia, $129.9 million (IQR, $128.7-$131.1); Boston, $128.7 million (IQR, $127.5-$129.9); Step-by-Step, $ 126.6 million (IQR, $125.4-$127.8); and PECARN, $125.8 million (IQR, $124.6-$127).
The Rochester, Step-by-step, and PECARN criteria are the least costly when evaluating infants 29-90 days of age with a fever.
比较用于评估 29-90 日龄发热婴儿的风险分层标准相关的医疗费用。
进行了一项成本分析研究，评估了波士顿、罗切斯特、费城、逐步和 PECARN 标准。从已发表的文献中获得了被认为低风险的婴儿比例和漏诊感染率。从医疗保险和医疗补助服务中心估算了急诊费用。使用医疗保健成本和利用项目数据库估算了每年 29-90 日龄发热婴儿的数量以及与漏诊感染相关的住院费用。使用具有 Dirichlet 先验的概率马尔可夫模型估计每个结果的转移概率分布，并使用伽马分布对成本进行建模。马尔可夫模拟估计了每个婴儿的预期年度费用分布和总年度费用。
对于低风险婴儿，各标准的婴儿平均成本为罗切斯特：$1050（IQR $1004-$1092），费城：$1416（IQR，$1365-$1465），波士顿：$1460（IQR，$1411-$1506），逐步：$942（IQR，$899-$981），PECARN：$1004（IQR，$956-$1050）。每年有 18522 名发热 1-3 个月大的婴儿就诊，根据标准计算的总平均费用如下：罗切斯特，$127.3 百万（IQR，$126.1-$128.5）；费城，$129.9 百万（IQR，$128.7-$131.1）；波士顿，$128.7 百万（IQR，$127.5-$129.9）；逐步，$126.6 百万（IQR，$125.4-$127.8）；PECARN，$125.8 百万（IQR，$124.6-$127）。
在评估 29-90 日龄发热婴儿时，罗切斯特、逐步和 PECARN 标准的成本最低。
