title: Cost of management of severe pneumonia in young children: systematic analysis.
abstract: BACKGROUND
  Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.
  
  
  METHODS
  We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non-severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate.
  
  
  RESULTS
  We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low- and-middle income countries (LMIC) and high-income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5-8.7), US$ 51.7 (95% CI 17.4-91.0) and US$ 242.7 (95% CI 153.6-341.4)-559.4 (95% CI 268.9-886.3) in community, out-patient facilities and different levels of hospital in-patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%-115.8% of patients' monthly household income in LMIC. The mean direct non-medical cost and indirect cost for severe pneumonia management accounted for 0.5-31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3-6.4) and 7.7 (IQR 5.5-9.9) days in LMIC and HIC respectively for these children.
  
  
  CONCLUSIONS
  This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, PR China.
authors.forename: Shanshan
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Sammon
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; NHS Grampian, UK.
authors.forename: Isobel
authors.initials: I
authors.lastname: King
authors.affiliation: Department of Community Health, Federal University of Goias, Brazil.
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Andrade
authors.affiliation: Department of Community Health, Federal University of Goias, Brazil.
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Toscano
authors.affiliation: Department of Community Health, Federal University of Goias, Brazil; State University of Maranhăo, Brazil.
authors.forename: Sheila N
authors.initials: SN
authors.lastname: Araujo
authors.affiliation: New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA.
authors.forename: Anushua
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia.
authors.forename: Gulam
authors.initials: G
authors.lastname: Khandaker
authors.affiliation: National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia.
authors.forename: Jiehui Kevin
authors.initials: JK
authors.lastname: Yin
authors.affiliation: National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
authors.affiliation: Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Tanvir M
authors.initials: TM
authors.lastname: Huda
authors.affiliation: Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
authors.forename: Qazi S
authors.initials: QS
authors.lastname: Rahman
authors.affiliation: Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina.
authors.forename: Angela
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authors.affiliation: Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina.
authors.forename: Norberto
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authors.affiliation: Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh.
authors.forename: Mejbah U
authors.initials: MU
authors.lastname: Bhuiyan
authors.affiliation: Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh; Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Sturm-Ramirez
authors.affiliation: Agence de Médicine Préventive, Paris, France.
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.affiliation: Faculty of Public Health, University of Indonesia, Jakarta, Indonesia.
authors.forename: Mardiati
authors.initials: M
authors.lastname: Nadjib
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA.
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Carosone-Link
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
authors.forename: Eric Af
authors.initials: EA
authors.lastname: Simões
authors.affiliation: Pharmacy Department, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Child
authors.affiliation: Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
authors.forename: Imran
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan.
authors.forename: Sajid B
authors.initials: SB
authors.lastname: Soofi
authors.affiliation: James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
authors.forename: Rumana J
authors.initials: RJ
authors.lastname: Khan
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Campbell
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India.
authors.forename: Harish
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mesh_terms: D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011014:Pneumonia / Q000191:economics* / Q000628:therapy*