Cost of Neonatal Intensive Care Delivered through District Level Public Hospitals in India.
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Date
2013-09
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Abstract
Objective: To assess the unit cost of level II neonatal intensive
care treatment delivered through public hospitals and its fiscal
implications in India.
Design: Cost analysis study.
Setting: Four Special Care Newborn Units (SCNUs) in public
sector district hospitals in three Indian states, i.e. Bihar, Madhya
Pradesh and Orissa, for the period 2010.
Methods: Bottom-up economic costing methodology was
adopted. Health system resources, i.e. capital, equipment, drugs
and consumables, non-consumables, referral and overheads,
utilized to treat all neonates during 2010 were elicited.
Additionally, 360 randomly selected treatment files of neonates
were screened to estimate direct out-of-pocket (OOP)
expenditure borne by the patients. In order to account for
variability in prices and other parameters, we undertook a
univariate sensitivity analysis.
Main Outcome Measures: Unit cost was computed as INR
(Indian national rupees) per neonate treated and INR per bed-day
treatment in SCNU. Standardized costs per neonate treatment
and per bed day were estimated to incorporate the variation in bed
occupancy rates across the sites.
Results: Overall, SCNU neonatal treatment costs the
Government INR 4581 (USD 101.8) and INR 818 (USD 18.2) per
neonate treatment and per bed-day treatment, respectively.
Standardized treatment costs were estimated to be INR 5090
(USD 113.1) per neonate and INR 909 (USD 20.2) per bed-day
treatment. In the event of entire direct medical expenditure being
borne by the health system, we found cost of SCNU treatment as
INR 4976 (USD 110.6) per neonate and INR 889 (USD 19.8) per
bed-day.
Conclusions: Level II neonatal intensive care at SCNUs is cost
intensive. Rational use of SCNU services by targeting its
utilization for the very low birth weight neonates and maintenance
of community based home-based newborn care is required.
Further research is required on cost-effectiveness of level II
neonatal intensive care against routine pediatric ward care.
Description
Keywords
Child health, Economic evaluation, SCNU, Neonatal intensive care, Costing
Citation
Prinja Shankar, Manchanda Neha, Mohan Pavitra, Gupta Gagan, Sethy Ghanashyam, Sen Ashish, Hombergh Henri van den Kumar Rajesh. Cost of Neonatal Intensive Care Delivered through District Level Public Hospitals in India. Indian Pediatrics. 2013 September; 50(9): 839-846.