Department of Pediatrics, Institute of Medicine, Child Health Research Project, Tribhuvan University, Kathmandu, Nepal.
Medical Department, Kanti Children's Hospital, Kathmandu, Nepal.
PLoS One. 2021 Nov 29;16(11):e0260127. doi: 10.1371/journal.pone.0260127. eCollection 2021.
Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal's Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3-59 days old, enrolled in a clinical trial, and admitted to the Kanti Children's Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3-28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29-59 days) were USD 111.7 (69.8-155.5) and 65.17 (43.4-98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017).
败血症是新生儿的一个重要且可预防的死亡原因，会给父母/监护人带来高昂的自费住院费用。尼泊尔的免费新生儿护理 (FNC) 服务覆盖住院费用，设定了最高限额为尼泊尔卢比 (NPR) 8000 ，即 73.5 美元，但其依据尚不清楚。我们旨在估算符合败血症临床标准的新生儿和婴儿的治疗费用，定义为临床严重感染 (CSI)，以确定增加费用的决定因素。这项研究评估了 206 名 3-59 天大的婴儿的治疗费用，这些婴儿参加了一项临床试验，并于 2017 年 6 月至 2018 年 12 月期间在尼泊尔坎蒂儿童医院住院。总费用是通过床位费用、检查和药物的直接费用以及父母工作时间损失的间接费用之和计算得出的。我们估算了 CSI 的治疗费用、超过 NPR 8000 的比例，并进行了多变量线性回归以确定高费用的决定因素。在 206 名婴儿中，138 名 (67%) 是新生儿 (3-28 天)。新生儿和婴儿 (29-59 天) CSI 治疗的直接费用中位数 (IQR) 分别为 111.7 美元 (69.8-155.5) 和 65.17 美元 (43.4-98.5)。69%的 CSI 新生儿的直接费用超过 NPR 8000 (73.5 美元)。年龄<29 天、中度营养不良、有任何病危迹象和记录的治疗失败被认为是 CSI 治疗高费用的重要决定因素。根据这项研究，在一家公立三级医院，CSI 新生儿的平均治疗费用相当高。公立医院免费新生儿护理提供的最高限额需要修订，以便更好地接受和成功实施 FNC 服务，避免在尼泊尔等发展中国家发生灾难性的医疗支出。试验注册： CTRI/2017/02/007966（注册于：2017 年 2 月 27 日）。
