Sultana Marufa, Watts Jennifer, Alam Nur H, Ali Nausad, Faruque Abu S G, Nasrin Sabiha, Chisti Mohammod Jobayer, Fuchs George J, Gyr Niklaus, Ahmed Tahmeed, Abimanyi-Ochom Julie, Gold Lisa
Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
Nutrition Research Division; icddr,b, Dhaka, Bangladesh.
PLoS One. 2025 May 8;20(5):e0323353. doi: 10.1371/journal.pone.0323353. eCollection 2025.
OBJECTIVE: Childhood severe pneumonia is the leading cause of under-five deaths in Bangladesh. A new day-care management approach (DCA) was implemented in primary-level healthcare facilities in urban and rural areas of Bangladesh. Reliable cost estimates are important to determine the economic viability of the new management approach. The objective of this study were to estimate the mean societal cost per patient for a new Day-care approach (DCA) in managing childhood severe pneumonia, to assess cost variation in urban and rural healthcare settings, and to determine important cost predictors. STUDY DESIGN: This study was conducted alongside a cluster randomized trial conducted in Bangladesh Children diagnosed with severe pneumonia were enrolled between November 2015 and March 2019. Employing a bottom-up micro-costing approach from a societal perspective, detailed household and provider cost data were collected from sixteen intervention facilities (n = 16). Data collection involved structured questionnaires administered face-to-face with facility staff, interviews with parents/caregivers, and patient record reviews. Analysis measured mean cost and cost variation across socio-economic groups, facility location, clinical variables, and determined cost-sensitive parameters. A p-value of < 0.05 was considered as statistically significant level. RESULTS: 1,745 children were enrolled, 63% were male, and 57% were less than a year old. The mean societal cost per patient was US$94.2 (95% CI: US$92.2, US$96.3) with a mean length-of-stay (LoS) of 4.1 days (SD ± 3.0). Costs of medical personnel (US$32.6), caregiver's productivity loss (US$26) and medicines (US$22) were the major cost contributors. Mean cost was significantly higher for urban-located facilities compared to rural (difference US$17, 95% CI: US$12.6, US$20.8). No cost variation was found by age, sex, and clinical variables. CONCLUSION: Findings suggest that this novel DCA management approach is a low-cost management option, and particularly beneficial for rural residences and therefore has the potential to reduce the overall cost burden for childhood severe pneumonia management. These findings have implications for policy-making decisions in resource-poor settings for childhood pneumonia management.
目的：儿童重症肺炎是孟加拉国五岁以下儿童死亡的主要原因。一种新的日托管理方法（DCA）在孟加拉国城乡地区的基层医疗机构中实施。可靠的成本估计对于确定新管理方法的经济可行性很重要。本研究的目的是估计采用新的日托方法（DCA）管理儿童重症肺炎时每位患者的平均社会成本，评估城乡医疗环境中的成本差异，并确定重要的成本预测因素。 研究设计：本研究是在孟加拉国进行的一项整群随机试验的同时开展的。2015年11月至2019年3月期间纳入了被诊断为重症肺炎的儿童。从社会角度采用自下而上的微观成本核算方法，从16个干预设施（n = 16）收集了详细的家庭和提供者成本数据。数据收集包括与设施工作人员面对面进行的结构化问卷调查、与父母/照顾者的访谈以及患者记录审查。分析测量了不同社会经济群体、设施位置、临床变量的平均成本和成本差异，并确定了成本敏感参数。p值<0.05被视为具有统计学意义。 结果：共纳入1745名儿童，其中63%为男性，57%年龄小于一岁。每位患者的平均社会成本为94.2美元（95%置信区间：92.2美元，96.3美元），平均住院时间（LoS）为4.1天（标准差±3.0）。医务人员成本（32.6美元）、照顾者的生产力损失（26美元）和药品成本（22美元）是主要的成本构成部分。与农村地区相比，城市地区设施的平均成本显著更高（差异为17美元，95%置信区间：12.6美元，20.8美元）。未发现年龄、性别和临床变量导致的成本差异。 结论：研究结果表明，这种新的DCA管理方法是一种低成本的管理选择，对农村居民尤其有益，因此有可能减轻儿童重症肺炎管理的总体成本负担。这些发现对资源匮乏地区儿童肺炎管理的政策决策具有启示意义。
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