Short-term health system costs of paediatric in-hospital acute life-threatening events including cardiac arrest.
OBJECTIVE
Acute life-threatening events in children are medical emergencies requiring immediate intervention. They can be due to cardiac arrest, respiratory arrest or another cause of sudden compromise for example, choking. Internationally, hospital systems are being introduced to reduce preventable acute life-threatening events and, despite having significant resource implications, have not yet been subject to economic analysis. This study presents the additional short-term health service costs of in-hospital acute life-threatening events to inform a cost-effectiveness analysis of prevention strategies.


METHODS
Patient level costs (GB pounds, price year 2005), in excess of baseline costs, were collected from a short-term NHS perspective. The cost per survivor to hospital discharge included the cost of the cardiopulmonary resuscitation attempt, resuscitation preparedness, and the cost of in-hospital post-resuscitation care. Acute life-threatening events calls were classified into two groups: cardiac arrest, and respiratory arrest and other acute life threatening events. Outcomes from these groups were compared to a similar group of unplanned Paediatric Intensive Care (PIC) admissions. All survival and length of stay outcomes were calculated for the first episode.


RESULTS
The survival to hospital discharge was 64.4% (65/101), (95% Confidence Intervals 55.02, 73.70) for all acute life-threatening event calls, and 41.3% (12/29), (95% Confidence Intervals 23.45, 59.31) for cardiac arrest. The mean cost of the resuscitation attempt was pound3664 for all acute life-threatening event calls, and pound3884 for cardiac arrest. The annual cost of cardiopulmonary resuscitation preparedness was pound181,565. The mean cost of the post-event length of stay in hospital was pound22,562 for cardiac arrest, pound26,335 for other acute life-threatening events, and pound26,138 for urgent PIC admissions. The cost per survivor to hospital discharge was pound53,289.


CONCLUSIONS
The short-term costs of paediatric in-hospital acute life-threatening events, including cardiac arrest, from an NHS perspective, are more expensive than those reported for adults, but similar to other life saving treatments. This new information will serve to improve efficiency in the current resuscitation programme and contribute to cost-effectiveness analysis of prevention strategies.
Duncan
H P
HP
Paediatric Intensive Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom. heather.duncan@bch.nhs.uk
Frew
E
E