Direct costs of community-acquired pneumonia for hospitalized children in Shanghai, China from 2018 to 2020: a cross-sectional analysis

Yingzi Ye; Ling Su; Yonghao Gui; Quan Lu; Jianguo Hong; Daoyang Wang; Danping Gu; Collin Yong; Ying Gu; Guoying Huang; Hong Xu; Libo Wang; Ying Wang; Hui Yu; Rui Feng; Xiaobo Zhang

doi:10.21037/tp-22-247

Direct costs of community-acquired pneumonia for hospitalized children in Shanghai, China from 2018 to 2020: a cross-sectional analysis

Transl Pediatr. 2023 Mar 31;12(3):308-319. doi: 10.21037/tp-22-247. Epub 2023 Mar 6.

Authors

Yingzi Ye^#^{1

2}, Ling Su^#¹, Yonghao Gui^{1

2}, Quan Lu^{2

3}, Jianguo Hong^{2

4}, Daoyang Wang⁵, Danping Gu², Collin Yong⁶, Ying Gu¹, Guoying Huang^{1

2}, Hong Xu^{1

2}, Libo Wang¹, Ying Wang⁷, Hui Yu^{1

2}, Rui Feng^{1

8}, Xiaobo Zhang^{1

2}

Affiliations

¹ Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
² Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China.
³ Department of Respiratory Disease, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁵ Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
⁶ Emergency Department, British Columbia Children's Hospital, Vancouver, Canada.
⁷ Department of Critical Care Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University, National Children's Medical Center, Shanghai, China.
⁸ Shanghai Key Laboratory of Intelligent Information Processing, School of Computer Science, Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Community-acquired pneumonia (CAP) is an acute respiratory infection with a high clinical and economic burden. Clarifying the burden is important for health policy making. However, there is inadequate data on the economic burden of childhood CAP in China. In this study, the direct disease burden of CAP in children was analyzed using city-level data.

Methods: A cross-sectional study of the direct costs of CAP for hospitalized children aged 28 days to 18 years old in Shanghai from January 2018 to December 2020 was performed. Information, including the hospitalization costs from the first page of the children's hospitalized medical records, was obtained. The direct costs included medical services, diagnostics, medications, and medical supplies. The continuous variables with non-normal distributions are expressed as the median (interquartile range). Comparisons between groups were performed using the Kruskal-Wallis H test. The enumeration data are expressed as the number (percentage), and comparisons between groups were performed using the χ² test.

Results: A total of 59 hospitals and 63,614 hospitalized CAP patients were included in this study. Significantly fewer patients were discharged in 2020 than 2018 and 2019 (6,662, 27,943, and 29,009, respectively, P<0.001). Among the patients, 27,741 patients (43.6%) were covered by social medical insurance, 13,509 (21.2%) by commercial health insurance, and 22,364 (35.2%) were self-paying. The annual total direct costs for 2018, 2019, and 2020 were 118.553, 140.865, and 40.064 million Chinese Yuan (CNY), respectively. The average direct costs per hospital stay due to pediatric CAP in Shanghai was 4,707.83 CNY in 2018, a sum that accounted for 7.3% and 16.7% of the per capita disposable income in Shanghai and China in 2018, respectively. The total costs of the group aged <1 year were significantly higher than those of the other age groups (6,271.1 vs. 3,244.3~4,610.7 CNY, P<0.001). The total costs of severe cases were significantly higher than those of non-severe cases (5,200.6 vs. 3,170.4 CNY, P<0.001). The median duration of hospital stay was 6.0 days (5.0, 8.0).

Conclusions: CAP hospitalization continues to represent a high clinical and economic burden in Shanghai, China. Specialized hospitals, severe cases, and the length of hospital stay were positively correlated with inpatient costs.

Keywords: Community-acquired pneumonia; costs analysis; economic burden; hospitalized children; pulmonary parenchyma.