Short-term health system costs of paediatric in-hospital acute life-threatening events including cardiac arrest |
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| Authors: | HP Duncan E Frew |
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| Institution: | 1. Paediatric Intensive Care, Birmingham Children''s Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom;2. Department of Health Economics, HSMC, Park House, 40 Edgbaston Park Road, University of Birmingham, B15 2RT, United Kingdom;1. National Competence Centre for Complex Symptom Disorders, Trondheim, Norway;2. Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;3. Department of Internal Medicine, Sørlandet Hospital HF, Kristiansand, Norway;4. Department of Pain and Complex Symptom Disorders, St. Olav’s University Hospital, Trondheim, Norway;5. Department of Pain Management and Research, Oslo University Hospital, University of Oslo, Oslo, Norway;6. Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway;1. Department of Mathematics, Technical University Munich, Munich, Germany;2. Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas;3. Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas;4. Memorial Sloan Kettering Cancer Center, New York, New York;1. Service d’explorations fonctionnelles pédiatriques, Hôpital d’Enfants, CHU de Nancy, France;2. EA 3450, Laboratoire de Physiologie, Faculté de Médecine, Université de Lorraine, France;1. Department of Nursing Education, St Jude Children''s Research Hospital, Memphis, Tennessee, USA;2. School of Nursing, University of Alabama at Birmingham, USA;3. Leeds Teaching Hospitals Trust, UK;4. School of Nursing, University of California, San Francisco, California, USA;5. Hospital de Pediatría Dr Juan P Garrahan, Buenos Aires, Argentina;6. Korle-Bu Teaching Hospital, Accra, Ghana;1. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria;2. Department of Neurology, Franz Tappeiner Hospital, Merano, Italy;3. Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria;4. Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy;5. Department of Physiology, Medical University of Graz, Graz, Austria |
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| Abstract: | ObjectivesAcute life-threatening events in children are medical emergencies requiring immediate intervention. They can be due to cardiac arrest, respiratory arrest or another cause of sudden compromise for example, choking. Internationally, hospital systems are being introduced to reduce preventable acute life-threatening events and, despite having significant resource implications, have not yet been subject to economic analysis. This study presents the additional short-term health service costs of in-hospital acute life-threatening events to inform a cost-effectiveness analysis of prevention strategies.MethodologyPatient level costs (GB pounds, price year 2005), in excess of baseline costs, were collected from a short-term NHS perspective. The cost per survivor to hospital discharge included the cost of the cardiopulmonary resuscitation attempt, resuscitation preparedness, and the cost of in-hospital post-resuscitation care. Acute life-threatening events calls were classified into two groups: cardiac arrest, and respiratory arrest and other acute life threatening events. Outcomes from these groups were compared to a similar group of unplanned Paediatric Intensive Care (PIC) admissions. All survival and length of stay outcomes were calculated for the first episode.ResultsThe survival to hospital discharge was 64.4% (65/101), (95% Confidence Intervals 55.02, 73.70) for all acute life-threatening event calls, and 41.3% (12/29), (95% Confidence Intervals 23.45, 59.31) for cardiac arrest. The mean cost of the resuscitation attempt was £3664 for all acute life-threatening event calls, and £3884 for cardiac arrest. The annual cost of cardiopulmonary resuscitation preparedness was £181,565.The mean cost of the post-event length of stay in hospital was £22,562 for cardiac arrest, £26,335 for other acute life-threatening events, and £26,138 for urgent PIC admissions. The cost per survivor to hospital discharge was £53,289.ConclusionThe short-term costs of paediatric in-hospital acute life-threatening events, including cardiac arrest, from an NHS perspective, are more expensive than those reported for adults, but similar to other life saving treatments. This new information will serve to improve efficiency in the current resuscitation programme and contribute to cost-effectiveness analysis of prevention strategies. |
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