title: Costing of severe pneumonia in hospitalized infants and children aged 2-36 months, at a secondary and tertiary level hospital of a not-for-profit organization.
abstract: OBJECTIVE
  To determine health care provider cost and household cost of the treatment of severe pneumonia in infants and young children admitted to secondary and tertiary level health care facilities.
  
  
  METHODS
  The study was done in a private, not-for-profit medical college hospital, in Vellore, India, in mid-2008. Children aged 2-36 months admitted with severe pneumonia with no underlying chronic disease were included in the study. The relatives were interviewed daily on matters relating to patients' view point of the costs. These were direct medical costs, direct non-medical costs which comprised travel, accommodation and special food during the period of illness, and indirect costs of productivity loss for family members. Patient specific resource consumption and related charges were recorded from charts, nursing records, pharmacy lists and hospital bills, and the providers view point of the costs was estimated. Unit cost estimates for bed days, treatment and investigation inputs were calculated.
  
  
  RESULTS
  Total cost to health care provider for one episode of hospitalized childhood pneumonia treated at secondary level was US$ 83.89 (INR 3524) and US$ 146.59 (INR 6158) at tertiary level. At both levels the greatest single cost was the hospital stay itself, comprising 74% and 56% of the total cost, respectively. Diagnostic investigations were a large expense and supportive treatment with nebulization and oxygen therapy added to the costs. Mean household expenditure on secondary level was US$ 41.35 (INR 1737) and at tertiary level was US$ 134.62 (INR 5655), the largest single expense being medicines in the former and the hospitalization in the latter. (one US$=INR 42.1 at time of study)
  
  
  CONCLUSIONS
  A considerable cost difference exists between secondary and tertiary level treatment. Admission at lowest possible treatment level for appropriate patients could decrease the costs borne by the provider and the patient.
authors.affiliation: Department of International Health, Copenhagen University, Denmark.
authors.forename: Helle Ostergaard
authors.initials: HO
authors.lastname: Madsen
authors.forename: Malin
authors.initials: M
authors.lastname: Hanehøj
authors.forename: Ashima Rani
authors.initials: AR
authors.lastname: Das
authors.forename: Prabhakar D
authors.initials: PD
authors.lastname: Moses
authors.forename: Winsley
authors.initials: W
authors.lastname: Rose
authors.forename: Mammen
authors.initials: M
authors.lastname: Puliyel
authors.forename: Flemming
authors.initials: F
authors.lastname: Konradsen
authors.forename: K R
authors.initials: KR
authors.lastname: John
authors.forename: Anuradha
authors.initials: A
authors.lastname: Bose
mesh_terms: D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000191:economics* / Q000401:mortality