Cost of hospitalisation for bronchiectasis exacerbation in children

Abstract

Introduction/Aim. Despite paediatric bronchiectasis being recognised increasingly worldwide, prior reports of hospitalisation costs for bronchiectasis in children are lacking. This study aimed to: (a) identify health service costs of hospitalisations and (b) factors associated with these costs in children admitted to an Australian paediatric hospital following an acute exacerbation of their bronchiectasis.

Methods. Demographic and hospital resource use data were prospectively recorded for 100 children aged <18‐years admitted consecutively to the Queensland Children's Hospital, Brisbane, Australia. Costs (2016 Australian dollars [AUD]) were obtained from the hospital's Finance Department. Linear regressions, with bootstrap resampling to quantify uncertainty, were used to estimated factors affecting cost of hospitalisation.

Results. The 100 hospitalisations (48 males) had a median (interquartile range) age of 6.04 (4.04 to 9.85) years. Their mean (standard deviation [SD]) length‐of‐stay (LOS) was 12.30 (4.60) days. The mean (SD) direct health service cost was AUD30,182 (13,998) per hospitalisation. The greatest contributor to costs was health professional wages, accounting for 70% of the cost per episode. The four explanatory factors independently associated with the cost of hospitalisation were LOS, age at admission, number of affected lobes and treatment using HITH. Each extra day in hospital cost AUD2,487.46, younger age increased the cost by AUD534.88 for every year, and for each additional lobe of lung affected by bronchiectasis there was a mean increase of AUD967.28 per hospitalisation respectively. Where HITH was used, it resulted in an average saving of AUD7,766.19/episode (USD5,765). The cost to families on average was AUD2,669.50 (SD 991.50) per hospitalisation when accounting for lost wages and opportunity cost.

Conclusion. The per episode healthcare cost burden of hospitalisations for paediatric bronchiectasis exacerbations is substantial. Interventions that prevent hospitalised exacerbations and reduce severity of childhood bronchiectasis with even moderate effectiveness are likely to result in substantial hospital costs savings.