title: Cost-effectiveness of improving pediatric hospital care in Nicaragua.
abstract: OBJECTIVE
  To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures.
  
  
  METHODS
  Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness.
  
  
  RESULTS
  Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204).
  
  
  CONCLUSIONS
  After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.
authors.affiliation: Health Care Improvement Project, United States Agency for International Development, University Research Co., LLC, Bethesda, Maryland, United States of America. ebrought@jhsph.edu
authors.forename: Edward I
authors.initials: EI
authors.lastname: Broughton
authors.forename: Ivonne
authors.initials: I
authors.lastname: Gomez
authors.forename: Oscar
authors.initials: O
authors.lastname: Nuñez
authors.forename: Yudy
authors.initials: Y
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003967:Diarrhea / Q000401:mortality / Q000628:therapy*; D003968:Diarrhea, Infantile / Q000401:mortality / Q000628:therapy; D016527:Drug Costs; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006776:Hospitals, Pediatric / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D009527:Nicaragua / Q000453:epidemiology; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015397:Program Evaluation; D058996:Quality Improvement / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents