Estimation of medical expenditure of initial various treatment regimes in hospitalized cases of severe community acquired pneumonia in children under 5 years of age in North India

Abstract

Introduction: Community acquired pneumonia (CAP) is among the leading causes of death in children under 5 years of age worldwide. In India 15% of child mortality is due to CAP. Aim and objectives: To enumerate direct and indirect medical expenditures and out of pocket expenditure incurred by parents and to calculate spending burden ratio (SBR) in hospitalized children of severe CAP under 5 years of age. Methodology: Prospective observational study conducted in a tertiary care, teaching hospital in India from September 2015 to August 2016 in children aged 1 month to 59 months hospitalized for WHO defined severe CAP. Included were cases treated on any of the following four regimens in first 48 h of admission: Amoxicillin-clavulanate(AC) only, Amoxycillin-clavulanate(AC) with aminoglycoside(A), 3rd generation cephalosporin(3GC) only and 3rd generation cephalosporin plus vancomycin (3GC + V). Clinical and expenditure data was abstracted from hospital chart review and from expenditure diary maintained by parents. SBR was calculated by dividing out of pocket expenditure by mean monthly income of family. Results: Out of 100 CAP patients recruited (66% were <12 months of age), distribution by antibiotic regime was as follows: AC 14(14%), AC + A 42 (42%), 3GC 18(18%) and 3GC + V 26(26%). History of prior use of antibiotic was present in 78% AC, 62% AC + A, 83% 3GC and 92% 3GC + V regime. Total mean direct expenditure of 100 cases was INR 10381(SD= 7954) of which 72% was incurred as expenditure on drugs and hospital charges. Mean direct medical expenditures was least in AC regime INR 6772(SD = 4808) which was 57% of family’s mean monthly income and most in 3GC + V regime, INR 17088(SD = 9387) being 260% of mean monthly income (p value <0.01). Mean indirect expenditure was similar in all regimes. SBR in AC regime was 0.39, in AC + A regime was 0.36, in 3GC regime was 0.55 and in 3GC + V regime was 1.01. (1 USD = 65 INR) Conclusion: In hospitalized children with CAP, Direct medical expenditure is driven by expenses on drugs and hospital charges.Therefore, reducing these would reduce total medical expenditure and thus financial burden on families of uninsured patients.