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Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal

Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal’s Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000...

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Autores principales: Shrestha, Suchita, Chapagain, Ram Hari, Purakayastha, Debjani Ram, Basnet, Srijana, Wadhwa, Nitya, Strand, Tor A., Basnet, Sudha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629207/
https://www.ncbi.nlm.nih.gov/pubmed/34843530
http://dx.doi.org/10.1371/journal.pone.0260127
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author Shrestha, Suchita
Chapagain, Ram Hari
Purakayastha, Debjani Ram
Basnet, Srijana
Wadhwa, Nitya
Strand, Tor A.
Basnet, Sudha
author_facet Shrestha, Suchita
Chapagain, Ram Hari
Purakayastha, Debjani Ram
Basnet, Srijana
Wadhwa, Nitya
Strand, Tor A.
Basnet, Sudha
author_sort Shrestha, Suchita
collection PubMed
description Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal’s Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3–59 days old, enrolled in a clinical trial, and admitted to the Kanti Children’s Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3–28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29–59 days) were USD 111.7 (69.8–155.5) and 65.17 (43.4–98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017).
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spelling pubmed-86292072021-11-30 Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal Shrestha, Suchita Chapagain, Ram Hari Purakayastha, Debjani Ram Basnet, Srijana Wadhwa, Nitya Strand, Tor A. Basnet, Sudha PLoS One Research Article Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal’s Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3–59 days old, enrolled in a clinical trial, and admitted to the Kanti Children’s Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3–28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29–59 days) were USD 111.7 (69.8–155.5) and 65.17 (43.4–98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017). Public Library of Science 2021-11-29 /pmc/articles/PMC8629207/ /pubmed/34843530 http://dx.doi.org/10.1371/journal.pone.0260127 Text en © 2021 Shrestha et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shrestha, Suchita
Chapagain, Ram Hari
Purakayastha, Debjani Ram
Basnet, Srijana
Wadhwa, Nitya
Strand, Tor A.
Basnet, Sudha
Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal
title Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal
title_full Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal
title_fullStr Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal
title_full_unstemmed Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal
title_short Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal
title_sort assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in nepal
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629207/
https://www.ncbi.nlm.nih.gov/pubmed/34843530
http://dx.doi.org/10.1371/journal.pone.0260127
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