Estimating the cost of hospital treatment for injuries using linked morbidity data

This paper describes the analysis of injury-related linked hospital morbidity data by admissions and by individual patients in Western Australia (WA) from 1990 to 1994. Over this five-year period, there were an average of 35,385 admissions and 30,524 people admitted each year for injuries in WA. The age-standardised rates for injury-related hospital admissions and persons admitted for injuries increased significantly, by 2.4% and 1.5% per year respectively, over the five-year period. The number of admissions and the number of persons admitted peaked in the 20–24 years age group but the highest rates were among those aged 75 years and above.
Injuries accounted for nearly 10% of all hospital bed day costs and cost about $50 per head of population per year. The cost of hospitalisation rose steadily from $85.2 million in 1990 to $113.6 million in 1994, the average cost being nearly $100 million per year. The average cost per injury related hospital episode was $2,748.
Generally, the cost per hospital episode was higher for males and increased with age, following a similar pattern to that for the average length of stay.     

Babies admitted to NICU/ICU: province of birth and mode of delivery matter

Neonatal intensive care units (NICUs) and intensive care units (ICUs) provide care for newborns in need of specialized medical attention. Across Canada, rates of NICU/ICU admission vary. Due to the high cost of monitoring and interventions these admissions cost more than general newborn stays - whether the newborn is in a specialized NICU or in an ICU in those facilities without specialized units for newborns. This study explores the variation in NICU/ICU admissions and the characteristics of mothers and newborns associated with an increased likelihood of NICU/ICU admission. We focus further on the association between NICU/ICU admission and Caesarean section (C-section). After excluding multiple births, preterm births, small for gestational age births and those delivered by women with select complications, we find an increased risk for NICU/ICU admission for babies born by C-section as their only indication. NICU/ICU admission following C-section alone may not represent the most desirable pathway of care for these newborns.     

An economic analysis of alternatives for childhood immunisation against Haemophilus influenzae type b disease

Abstract: Cost-effectiveness and cost-utility analyses of immunisation strategies against invasive Haemophilus influenzae type b (Hib) disease in Australia were based on a hypothetical birth cohort of 250 000 non-Aboriginal Australian children. The model predicted that, without immunisation, 625 cases of invasive Hib disease would occur in under-five-year-olds, with direct costs of $10.2 million. Universal public sector vaccination beginning before six months of age (6MVAC) prevented 80 per cent of cases; vaccination at 12 months (12MVAC) 62 per cent and at 18 months (18MVAC) 46 per cent At a vaccine cost of $15 per dose, 18MVAC gave the lowest cost per quality-adjusted life year (QALY) over a wide range of model assumptions, with 6MVAC the ‘best’ alternative. The best estimate ($ per QALY) for 6MVAC was $6930 (three doses), for 12MVAC $9136 (two doses) and for 18MVAC $1231 (one dose). The cost per QALY of single dose catch-up immunisation of older children was estimated at $8630 at two years, $27 000 at three years and $117 000 at four years if done at a scheduled visit; these values were increased if an additional medical visit was included. The threshold cost per vaccine dose at which an immunisation program became cost-saving was estimated for 6MVAC, 12MVAC and 18MVAC as $11, $10 and $14. Even under a worst-case scenario, an immunisation program at 6, 12 or 18 months became cost-saving if indirect costs of death were included. Comparison with previous analyses revealed the importance of the incidence and age distribution of disability and assumptions about vaccine administration costs in determining model outcomes.     

Cost effectiveness of rotavirus vaccination in Australia

OBJECTIVE: Rotavirus gastroenteritis causes substantial morbidity, including hospital admission, in young children. In the context of recent vaccine developments, this study aimed to estimate the cost-effectiveness of a rotavirus vaccination program in Australia. METHOD: Standard methods of health economic evaluation were used to assess the total cost of rotavirus immunisation (as the difference between estimated vaccination program costs and the cost of disease that would be avoided by immunisation) and relate this to the number of cases of disease that would be prevented. Estimates were made from both societal and health care systems perspectives. RESULTS: Based on Australian data on disease incidence and cost of hospitalisation, the current annual cost of rotavirus disease is about $26.0 million. Using conservative vaccine efficacy estimates, current immunization uptake rates and a cost of $30 per dose of vaccine, rotavirus immunisation would incur a net societal cost of $2.9 million ($11 per child), at a gross program cost of $21.6 million. These estimates are sensitive to two sources of uncertainty in the estimation of program delivery costs: vaccine price and whether separate immunization visits would be required. CONCLUSION: A rotavirus immunisation program would be cost-neutral to Australian society at a vaccine price of $26 per dose (or $19 when health care system costs only are considered). IMPLICATIONS: Rotavirus immunization may be cost-effective in Australia, but considerable uncertainty remains. Policy decisions will depend heavily on pricing of the vaccine and may also need to consider intangible costs not accounted for in this analysis.     

Hypertensive emergency: case criteria, sociodemographic profile, and previous care of 100 cases.

To study the frequency, cost, sociodemographic profile, and previous care correlates of hospital admissions for hypertensive emergency, we used specific case criteria to identify a series of 100 cases at Presbyterian Hospital in New York City. Approximately 58 cases were admitted per year. Mean length of hospital stay was 11.8 days, 75 per cent of patients received intensive care, and estimated annual hospital charges were $438,828 (1986 dollars). Cases had severe hypertension on admission (mean systolic blood pressure, 229.8 mmHg; mean diastolic blood pressure, 143 mmHg). Two-thirds had clinical evidence of acute arteriolitis. Cases were predominantly young, male, Black or Hispanic, and of lower socioeconomic status. At least 93 per cent of cases were previously diagnosed, and at least 83 per cent were aware of their diagnosis of hypertension. Improved management of chronic hypertension rather than more intensive screening may be a useful strategy to reduce the incidence of hypertensive emergency.     

Variation in the use of alternative levels of hospital care for newborns in a managed care organization

OBJECTIVE(S): To assess the extent to which variation in the use of neonatal intensive care resources in a managed care organization is a consequence of variation in neonatal health risks and/or variation in the organization and delivery of medical care to newborns. STUDY DESIGN: Data were collected on a cohort of all births from four sites in Kaiser Permanente by retrospective medical chart abstraction of the birth admission. Likelihood of admission into a neonatal intensive care unit (NICU) is estimated by logistic regression. Durations of NICU stays and of hospital stay following birth are estimated by Cox proportional hazards regression. RESULTS: The likelihood of admission into NICU and the duration of both NICU care and hospital stay are proportional to the degree of illness and complexity of diagnosis. Adjusting for variation in health risks across sites, however, does not fully account for observed variation in NICU admission rates or for length of hospital stay. One site has a distinct pattern of high rates of NICU admissions; another site has a distinct pattern of low rates of NICU admission but long durations of hospital stay for full-term newborns following NICU admission as well as for all newborns managed in normal care nurseries. CONCLUSIONS: Substantial variations exist among sites in the risk-adjusted likelihood of NICU admission and in durations of NICU stay and hospital stay. Hospital and NICU affiliation (Kaiser Permanente versus contract) or affiliation of the neonatologists (Kaiser Permanente versus contract) could not explain the variation in use of alternative levels of hospital care. The best explanation for these variations in neonatal resource use appears to be the extent to which neonatology and pediatric practices differ in their policies with respect to the management of newborns of minimal to moderate illness.     

Investing in CenteringPregnancy™ Group Prenatal Care Reduces Newborn Hospitalization Costs

ObjectivesCenteringPregnancy™ group prenatal care is an innovative model with promising evidence of reducing preterm birth. The outpatient costs of offering CenteringPregnancy pose barriers to model adoption. Enhanced provider reimbursement for group prenatal care may improve birth outcomes and generate newborn hospitalization cost savings for insurers. To investigate potential cost savings for investment in CenteringPregnancy, we evaluated the impact on newborn hospital admission costs of a pilot incentive project, where BlueChoice Health Plan South Carolina Medicaid managed care organization paid an obstetric practice offering CenteringPregnancy $175 for each patient who participated in at least five group prenatal care sessions.MethodsUsing a one to many case-control matching without replacement, each CenteringPregnancy participant was matched retrospectively on propensity score, age, race, and clinical risk factors with five individual care participants. We estimated the odds of newborn hospital admission type (neonatal intensive care unit [NICU] or well-baby admission) for matched CenteringPregnancy and individual care cohorts with four or more visits using multivariate logistic regression. Cost savings were calculated using mean costs per admission type at the delivery hospital.ResultsOf the CenteringPregnancy newborns, 3.5% had a NICU admission compared with 12.0% of individual care newborns (p < .001). Investing in CenteringPregnancy for 85 patients ($14,875) led to an estimated net savings for the managed care organization of $67,293 in NICU costs.ConclusionsCenteringPregnancy may reduce costs through fewer NICU admissions. Enhanced reimbursement from payers to obstetric practices supporting CenteringPregnancy sustainability may improve birth outcomes and reduce associated NICU costs.     

Epidemiology and aetiology of acute bronchiolitis in Hong Kong infants.

The epidemiological, clinical and virological features of 1220 children with acute bronchiolitis admitted to the Prince of Wales Hospital, Hong Kong, from 1985 to 1988 are reported. They accounted for 6.6% of total paediatric admissions and provided a case incidence of bronchiolitis requiring admission to hospital of approximately 21 per 1000 children 0-24 months of age. The clinical course and outcome was in general benign. The average hospital stay was 5 days and there were no deaths. Ten per cent of patients were repeatedly admitted to hospital with recurrent wheezing after discharge. Two infants developed bronchiolitis obliterans. Respiratory syncytial virus (RSV) was shown by direct immunofluorescence, virus culture and serology to be the commonest cause of acute bronchiolitis in Hong Kong. Other aetiological agents included parainfluenza and influenza viruses, adenoviruses, and Mycoplasma pneumoniae. In contrast to western countries, a seasonal variation of bronchiolitis was found with a peak incidence in the summer months. The significance of these observations is discussed.     

An injury awareness education program on outcomes of juvenile justice offenders in Western Australia: an economic analysis

ABSTRACT: BACKGROUND: Injury is a major cause of mortality and morbidity of young people and the cost-effectiveness of many injury prevention programs remains uncertain. This study aimed to analyze the costs and benefits of an injury awareness education program, the P.A.R.T.Y. (Prevent Alcohol and Risk-related Trauma in Youth) program, for juvenile justice offenders in Western Australia. METHODS: Costs and benefits analysis based on effectiveness data from a linked-data cohort study on 225 juvenile justice offenders who were referred to the education program and 3434 who were not referred to the program between 2006 and 2011. RESULTS: During the study period, there were 8869 hospitalizations and 113 deaths due to violence or traffic-related injuries among those aged between 14 and 21 in Western Australia. The mean length of hospital stay was 4.6 days, a total of 320 patients (3.6%) needed an intensive care admission with an average length of stay of 6 days. The annual cost saved due to serious injury was $3,765 and the annual net cost of running this program was $33,735. The estimated cost per offence prevented, cost per serious injury avoided, and cost per undiscounted and discounted life year gained were $3,124, $42,169, $8,268 and $17,910, respectively. Increasing the frequency of the program from once per month to once per week would increase its cost-effectiveness substantially. CONCLUSIONS: The P.A.R.T.Y. injury education program involving real-life trauma scenarios was cost-effective in reducing subsequent risk of committing violence or traffic-related offences, injuries, and death for juvenile justice offenders in Western Australia.     

Economic burden of hospital admissions for patients with acute bacterial skin and skin structure infections in the United States

ABSTRACT

Objectives: We estimated the total US hospital costs associated with acute bacterial skin and skin structure infection (ABSSSI) admissions as well as the admissions that may have been potential candidates for outpatient parenteral antimicrobial therapy (OPAT).

Methods: We assessed inpatient admissions for ABSSSI from the Premier database (2011–2014), focusing on all admissions of adults with length of stay (LOS) ≥ 1 days and a primary diagnosis of erysipelas, cellulitis/abscess, or wound infection. We performed a detailed analysis of 2014 admissions for patient, treatment, hospital, and economic characteristic variables. Using published selection criteria, we identified a subset of patients admitted in 2014 who may have been potential candidates for OPAT.

Results: We analyzed 277,971 admissions. In 2014, most admissions were for cellulitis without major complications or comorbidities; mean ± SD LOS was 4.0 ± 3.0 days, and total hospital cost per admission was $6400 ± $6874, 54% of which was attributable to room costs. Among 2014 admissions, 14% involved patients with clinical characteristics suggesting that they were consistent with guideline recommendations for exclusive treatment with OPAT. Compared with all admissions in the year, these admissions were of younger patients (aged 50 vs. 55 years), admitted more frequently for cellulitis (90% vs. 70%), with shorter LOS (2.8 ± 1.8 days), and lower mean total hospital cost per admission ($4080 ± $3066).

Conclusions: Admissions for ABSSSI impose a substantial cost to US hospitals, with half of costs attributable to room costs. When extrapolated to all US patients admitted to the hospital for ABSSSI during 2014, had OPAT guidelines been universally followed, admissions may have been reduced by 14%, thereby saving US hospitals $161 million.     

Assessing the appropriateness of paediatric hospital admissions in the United Kingdom

BACKGROUND: In order to assess whether the documented rise in paediatric admissions was due to inappropriate admissions, an objective measure of the appropriateness of paediatric admissions, modified for use in the United Kingdom, was used to measure the level of inappropriate admissions. The relationship of appropriateness of admissions to age, gender, time of admission and source of referral was investigated. METHODS: A retrospective review was carried out of a sample of paediatric records in 13 NHS district general hospitals in South Eastern England between April 1990 and March 1991 using the Paediatric Appropriateness Evaluation Protocol (PAEP) modified for use in the United Kingdom. RESULTS: A total of 3,324 paediatric admissions in 13 hospitals were assessed. Eight per cent of the sampled admissions were inappropriate. Age [odds ratio (OR)=0.87], gender (OR = 1.39) and weekend admissions (OR = 1.42) were associated with inappropriate admissions. After controlling for these factors, there was no significant variation between hospitals. CONCLUSION: The low level of inappropriate admissions may be a reflection of well-developed primary care services in the United Kingdom. Alternatives to hospital admission for the assessment of minor self-limiting illness in young children may have a role in reducing inappropriate admissions.     

The burden of rotavirus-related illness among young children on the Australian health care system

OBJECTIVE: To provide estimates of the annual number and cost of hospital admissions, emergency department (ED) visits and general practitioner (GP) visits for rotavirus (RV) related acute gastroenteritis (AGE) in young children in Australia. METHODS: Numbers of hospitalisations for AGE were determined from national hospital morbidity data from July 1998 to June 2003. The fraction of these hospitalisations that may be attributed to RV was estimated by direct linkage of hospital admissions and pathology data from hospitals in two regions of Australia and by a second indirect method using the seasonal variation of RV infection. Numbers of ED visits were estimated using statewide data from Victoria and New South Wales (NSW), and numbers of GP visits were estimated from representative sample data for GP visits. Costs of RV hospital admissions and ED visits were estimated from national hospital cost data. RESULTS: RV continues to account for around 10,000 hospitalisations annually for children aged less than five in Australia at an average cost of 1890 dollars each. There are an additional 22,000 ED visits a year where the child is not subsequently hospitalised, each at a cost of 320 dollars, and approximately 115,000 visits to GPs by children in this age group for RV-AGE at a cost of 36.60 dollars each. CONCLUSIONS: The annual cost of hospital admissions, ED visits and GP visits associated with RV infection in young children in Australia is approximately 30 million dollars. IMPLICATIONS: Vaccination against RV disease in Australia may provide substantial savings to the health care system, depending on the cost and effectiveness of an immunisation program.     

Economic impact of the introduction of an acellular pertussis vaccine in Canada: A 6-year analysis

Background

Between July 1997 and April 1998, Canadian public health agencies switched from the whole cell vaccine to the acellular vaccine for pertussis immunization. The acellular vaccine provided better efficacy and fewer adverse events than the whole cell vaccine did.

Objective

To determine the economic impact of replacing the whole cell vaccine with an acellular vaccine in Canada.

Methods

A decision analytic model was developed comparing costs and outcomes of pertussis vaccination for Canadian children born in the years 1991–2004. Effectiveness was measured as number of avoided pertussis cases as well as the number of avoided hospital admissions. Incremental costs per avoided pertussis case and per avoided hospital admission were calculated for Ministry of Health (MoH) and societal (SOC) perspectives. Various one-way sensitivity analyses as well as a Monte Carlo simulation were performed by varying key model parameters.

Results

The switch in immunization programs resulted in an incremental cost to the MoH of CAD $108 per pertussis case avoided (CAD $0.96 per child-year). From the SOC perspective, there was a savings of CAD $184 per pertussis case avoided (CAD $0.13 per child-year). The one-way sensitivity analyses provided incremental cost-effective ratios (ICERs) ranging from an incremental cost of CAD $1034 per avoided pertussis case from the MoH perspective to a saving of CAD $1583 per avoided case from the SOC perspective. The Monte Carlo simulation confirmed the robustness of these results.

Conclusions

Pertussis vaccination with AcE was cost-saving from the societal perspective and cost-effective from the Ministry of Health perspective.     

Two nosocomial pertussis outbreaks and their associated costs - King County, Washington, 2004.

OBJECTIVE: Pertussis outbreaks in healthcare settings result in resource-intensive control activities, but studies have rarely evaluated the associated costs. We describe and estimate costs associated with 2 nosocomial pertussis outbreaks in King County, Washington, during the period from July 25 to September 15, 2004. One outbreak occurred at a 500-bed tertiary care hospital (hospital A), and the other occurred at a 250-bed pediatric hospital (hospital B). METHODS: We estimated the costs of each outbreak from the hospitals' perspective through standardized interviews with hospital staff and review of contact tracing logs. Direct costs included personnel time and laboratory and medication costs, whereas indirect costs were those resulting from hospital staff furloughs. RESULTS: Hospital A incurred direct costs of $195,342 and indirect costs of $68,015; hospital B incurred direct costs of $71,130 and indirect costs of $50,000. Cost differences resulted primarily from higher personnel costs at hospital A ($134,536), compared with hospital B ($21,645). Total cost per pertussis case was $43,893 for hospital A (6 cases) and $30,282 for hospital B (4 cases). Total cost per person exposed to a pertussis patient were $357 for hospital A (738 exposures) and $164 for hospital B (737 exposures). CONCLUSIONS: Nosocomial pertussis outbreaks result in substantial costs to hospitals, even when the number of pertussis cases is low. The cost-effectiveness of strategies to prevent nosocomial pertussis outbreaks, including vaccination of healthcare workers, should be evaluated.     

Variation in management of community-acquired pneumonia requiring admission to Alberta,Canada hospitals

Previous studies have shown small area variation in the rate of admission to hospital for patients with community-acquired pneumonia. We determined the rates of admission and length of stay for patients with community-acquired pneumonia in Alberta and the factors influencing admission rates and length of stay. Using hospital abstracts, hospital admissions for community-acquired pneumonia from 1 April 1994 to 31 March 1999 were compared. We classified Alberta hospitals according to geographical regions, by the number of beds, and by number of community-acquired pneumonia cases. There were 12,000 annual hospital discharges for community-acquired pneumonia costing over $40 million per year. The overall in-hospital mortality rate was 12% and the 1 year mortality rate was 26%. Compared with rural hospitals, regional and metropolitan hospitals admitted patients with greater severity of illness as demonstrated by greater in-hospital mortality, cost per case and comorbidity. Age-sex adjusted hospital discharge rates were significantly below the provincial average in both urban regions. Hospital discharge rates for residents in all rural regions and 4 of 5 regions with a regional hospital were significantly higher than the provincial average. After adjusting for comorbidity, the relative risk for a longer length of stay was 22% greater in regional hospitals and about 30% greater in urban hospitals compared to rural hospitals. Seasonal variation in the admission rate was evident, with higher rates in the winter of each year. We conclude that rural hospitals would be likely to benefit from a protocol to help with the admission decision and urban hospitals from a programme to reduce length of stay.     

Costs and benefits of a second measles inoculation of children in Israel, the West Bank, and Gaza.

STUDY OBJECTIVE--Measles has been targeted by the WHO as a disease which should be eradicated. Use of existing vaccines during infancy has resulted in a substantial decline in cases in Israel, the West Bank, and Gaza. However the disease continues to occur in epidemic waves with large scale morbidity and mortality in all of these populations. This paper estimates the costs and benefits of three alternative strategies of adding immunisation at school age, and during young adult life to the present vaccination at 15 months. MEASUREMENTS AND MAIN RESULTS--A policy of immunising all Israeli children aged 6 (option A) would cost around $1 million and have estimated benefits of $4.5 million, yielding a benefit cost ratio of 4.53/1. Despite relatively lower medical care costs and work absence costs (as a result of the lower per capita GNP and lower female participation rate in the workforce), the West Bank and Gaza situations yield benefit to cost ratios of 5.74/1 and 9.59/1 respectively because of their relatively higher incidence rates. If implemented in Israel, a vaccination programme (such as option A) would prevent, over the next 10 years, approximately 28,700 simple cases, 3400 hospital admissions, eight non-fatal cases of encephalitis, and 2.2 cases of SSPE. It would save 28 lives. The adoption of option A, is expected to reduce incidence and mortality by around 13,600 and 32 cases in the West Bank, and by 18,000 and 64 cases in Gaza. CONCLUSION--The adoption of a two dose policy appears to be economically justifiable.     

Salmonella typhimurium phage type 170 in a tertiary paediatric hospital with person-to-person transmission implicated

Nosocomially-acquired salmonellosis is uncommonly reported in Australia. We report a cluster of gastroenteritis caused by Salmonella Typhimurium phage type 170 (STm 170) centred on a tertiary paediatric hospital in Sydney, New South Wales from 8 to 19 May 2004. A total of 12 children had STm 170 isolated from faecal specimens. Of the 12 cases, seven were acquired in hospital and five in the community. The mean age of the cases was 4.1 years (range: 2 months to 11.2 years). We conducted a case series investigation to generate hypotheses regarding the cause of this outbreak. Standardised interviews with cases' parents were conducted to identify potential exposures including in recently consumed food. An environmental investigation mapped the food preparation and storage areas, movements of staff caring for cases, relative case-bed locations, and duration of stay in these locations. Five of the seven hospital-acquired cases were immunocompromised with a history of prolonged and/or multiple hospital admissions. We found that STm 170 was probably brought into the hospital by a community-acquired case and spread to other in-patients through person-to-person transmission by hospital staff and/or patients. This study emphasises the importance of stringent compliance with hospital infection control practices at all times.     

Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance.

OBJECTIVE: To determine the mortality, hospital stay, and total hospital charges and cost of hospitalization attributable to candidemia by comparing patients with candidemia with control-patients who have otherwise similar illnesses. Prior studies lack broad patient and hospital representation or cost-related information that accurately reflects current medical practices. DESIGN: Our case-control study included case-patients with candidemia and their cost-related data, ascertained from laboratory-based candidemia surveillance conducted among all residents of Connecticut and Baltimore and Baltimore County, Maryland, during 1998 to 2000. Control-patients were matched on age, hospital type, admission year, discharge diagnoses, and duration of hospitalization prior to candidemia onset. RESULTS: We identified 214 and 529 sets of matched case-patients and control-patients from the two locations, respectively. Mortality attributable to candidemia ranged between 19% and 24%. On multivariable analysis, candidemia was associated with mortality (OR, 5.3 for Connecticut and 8.5 for Baltimore and Baltimore County; P < .05), whereas receiving adequate treatment was protective (OR, 0.5 and 0.4 for the two locations, respectively; P < .05). Candidemia itself did not increase the total hospital charges and cost of hospitalization; when treatment status was accounted for, having received adequate treatment for candidemia significantly increased the total hospital charges and cost of hospitalization ($6,000 to $29,000 and $3,000 to $22,000, respectively) and the length of stay (3 to 13 days). CONCLUSION: Our findings underscore the burden of candidemia, particularly regarding the risk of death, length of hospitalization, and cost associated with treatment.     

Economic evaluation of an extended acellular pertussis vaccine programme for adolescents in Ontario, Canada

PURPOSE: Pertussis is a frequent cause of cough illness in adolescents. In Canada, until recently immunization against pertussis in public programmes has been restricted to children under the age of 7. The purpose of this analysis was to estimate the health and economic impact of an additional booster dose of the acellular vaccine in adolescents in Ontario. METHODS: We performed a cost effectiveness analysis, based on a predictive spreadsheet dynamic model following a cohort of 144,000 adolescents in Ontario from the age of 12 years over a 10-year-period from the Ontario Ministry of Health (MoH) and societal perspectives. The model was used to compare costs and benefits of a combined vaccination programme (CVP) including tetanus, diphtheria, and acellular pertussis (dTacp) administered at age 12, compared to current practice. RESULTS: From the MoH perspective, booster vaccination of dacpT at 12 years via the CVP would produce a yearly additional expected cost of CAD $0.52 per adolescent in Ontario with an incremental cost-effectiveness ratio of CAD $168 per pertussis case avoided based on a 10-year-period. If outcomes are discounted at 3%, the incremental cost-effectiveness ratio rises to $188/discounted pertussis case avoided. From the societal perspective, the CVP would be cost saving CAD $858,106 at 10 years for the cohort. Over the 10-year-period, more than 4400 cases of pertussis would be prevented with approximately 50 hospital admissions averted. CONCLUSIONS: This study suggests that administering a booster dose of dTacp at 12 years of age to replace diphtheria and tetanus vaccination at 14 years may reduce the economic burden of pertussis treatment in the long term at a reasonable cost.     

Predictors of short-term readmission of asthmetic children

BACKGROUND: Bronchial asthma admission rate has increased dramatically all over the world. Part of this increase in hospital admissions is due to patients' readmission. OBJECTIVE: Determining what risk factors are associated with short-term hospital readmission of pediatric patients with asthma within two months of the last hospital admission. METHODS AND SETTING: A retrospective case-control study using registration books of both admissions and discharges to identify patients groups. All hospital records were reviewed for patients admitted from August 1998 through December 2002 at Assir Central Hospital, southwestern of Saudi Arabia. Patients who were admitted at this period of study and they were readmitted to the hospital within two months constituted the study group (n = 28) and those patients who were admitted within the same period but not readmitted within two months constituted the control group (n = 45). Demographic variables, route of admission, patient previous medical history, clinical assessment, hospital treatment as well as discharge treatment were extracted from medical records. RESULTS: twenty eight patients were readmitted within two months of the discharge from hospital (17 boys and 11 girls), seventy percent of these were below four years of age. Significant predictors of readmission were; prior history of asthma admission (adjusted OR 1.81 (1.20-2.73), NICU graduate (adjusted OR 4.44 (1.67-6.34), chronic lung disease (adjusted OR 3.06, 95% CI 2.01-4.95), tracheosphageal fistula (Adjusted OR 3.19, 95% CI 1.08-8.74), recurrent aspiration (adjusted OR 3.14, 95% CI 1.90-4.27), duration of asthma symptoms more than four days (adjusted OR 0.23, CI 0.21-0.42), moderate to severe clinical assessment (adjusted OR 1.67-95% CI 1.15-3.04), intensive care admission (adjusted OR 2.96, 95% CI 1.09-8.63), intravenous steroids ( adjusted OR 2.21,95% CI 1.36-4.67), and chest x-ray findings (adjusted OR 0.39, 95% CI:0.20-0.64). CONCLUSION: Previous NICU admission, bronchopulmonary dyspalsia, and history of previous asthma admissions, tracheosophageal fistula, recurrent aspirations, intensive care admission, intubation and intravenous steroids were significant predictors of asthma short readmission.