Cost of neonatal intensive care in a tertiary care center.

BACKGROUND: The number of neonatal intensive care units (NICUs) in India has increased substantially over the last decade; yet many more are required. There is limited information on the actual costs of setting up and running an NICU in India. OBJECTIVE: Systematic and comprehensive calculation and analysis of the costs of neonatal intensive care in a tertiary care teaching hospital. METHODS: The costs were compiled by studying the detailed records of various hospital departments and prospectively documenting the costs of drugs, consumables and investigations for a representative group of 30 babies. RESULTS: The total cost of establishing a 16 bed level III tertiary care NICU was Rs 3.78 crore (Rs. 37.8 million, USdollar 860,000) (2003). Equipment cost formed two-thirds of the establishment cost. The running cost of NICU care per patient per day was Rs 5450 (USdollar 125). NICU and ancillary personnel salary comprised the largest proportion of the running costs. The average total cost of care for a baby less than 1000 grams was Rs. 168000 (USdollar 3800), Rs. 88300 (USdollar 2000) for babies 1000 g to 1250 g. and Rs. 41700 (USdollar 950) for those between 1250 to 1500 g. The family had to bear only 25 percent; rest was subsidized. CONCLUSIONS: Equipment and personnel salary form the biggest proportion of establishment and running costs. The costs of treatment for a baby in NICU should be seen in context with costs of other types of health care and the number of useful life years gained.

Surfactant replacement therapy--economic impact.

Surfactant replacement is an effective treatment for neonatal respiratory distress syndrome. (RDS). As widespread use of surfactant is becoming a reality, it is important to assess the economic implications of this new form of therapy. A comparison study was carried out at the Neonatal Intensive Care Unit (NICU) of Northwest Armed Forces Hospital, Saudi Arabia. Among 75 infants who received surfactant for RDS and similar number who were managed during time period just before the surfactant was available, but by set criteria would have made them eligible for surfactant. All other management modalities except surfactant were the same for all these babies. Based on the intensity of monitoring and nursing care required by the baby, the level of care was divided as: Level IIIA, IIIB, Level II, Level I. The cost per day per bed for each level was calculated, taking into account the use of hospital immovable equipment, personal salaries of nursing, medical, ancillary staff, overheads and maintenance, depreciation and replacement costs. Medications used, procedures done, TPN, oxygen, were all added to individual patient's total expenditure. 75 infants in the Surfactant group had 62 survivors. They spent a total of 4300 days in hospital. (av 69.35) Out of which 970 d (av 15.65 per patient) were ventilated days. There were 56 survivors in the non-surfactant group of 75. They had spent a total of 5023 days in the hospital (av 89.69/patient) out of which 1490 were ventilated days (av 26.60 d). Including the cost of surfactant (two doses), cost of hospital stay for each infant taking the average figures of stay would be SR 118, 009.75 per surfactant treated baby and SR 164, 070.70 per non-surfactant treated baby. The difference of 46,061 SR is 39.03% more in non-surfactant group. One Saudi rial = 8 Rs (approx at the time study was carried out.) Medical care cost varies from place to place. However, it is definitely cost-effective where surfactant is concerned. Quality adjusted life years (QALY) for NICU care compares favourably with cost per QALY of several forms of adult health interventions. Audit, both medical and financial, of these services, at regular intervals is essential.

Care mapping: a common sense approach.

Because of trends in the health care environment, hospitals are searching for ways to continuously improve the quality of care and to decrease the costs of care. One approach that is gaining widespread recognition throughout the United States is the use of case management and practice guidelines such as critical paths, CareMaps, and in the neonatal field, NeoMaps. The NeoMap is a clinical tool which delineates practice guidelines for each discipline that provide care to a specific infant population. It reduces variation in clinical process and thereby has been shown to improve the quality of infant care. When practice guidelines are linked to both health and economic outcomes, they have significant impact on health care costs. In this paper, case management and the development of the NeoMap will be described in relation to the Intensive Care Nursery (ICN) at Pennsylvania Hospital.

Cost of neonatal intensive care.

Neonates are among those patients generating the highest hospital costs in recent years. There are no published data on the costs of neonatal intensive care in our country. The aim of our study was to analyse the cost of neonatal intensive care in a tertiary care unit. The average hospital charges per day were higher among non-survivors (Rs. 1857) compared to survivors (Rs. 727). Care of more than 1250 gms infant is cost beneficial in our set up.

Costo día por recién nacido en la unidad de terapia intensiva neonatal de la Maternidad Concepción Palacios / Cost for day of newborn in the intensive neonatal care unit of the Maternidad Concepción Palacios

La Maternidad Concepcion Palacios, asiste entre 2300 y 2400 nacimientos por mes, de los cuales sólo un 0,67 por ciento ingresan a la unidad de cuidados neonatales intensivos. Se determinó el costo de cada paciente asistido en la unidad, con el objetivo de dar a conocer los resultados y presentar el minucioso método de cálculo de esta evaluación económica. La investigación se realizó durante el mes de marzo de 1996, resultando un total de 645754 bolívares por cada neonato que atendió la unidad; con un costo al momento del ingreso de 26521 y un gasto diario de 45699 bolívares. Contamos con un promedio cama-día de 8, un porcentaje de ocupación del 85 por ciento, un promedio de estancia de 13 días y un intervalo de sustitución de 3 días. De la unidad egresan mensualmente 13 casos con una mortalidad del 42 por ciento

Mechanical ventilation of newborns: experience from a level II NICU.

OBJECTIVES: To analyse the indications, clinical profile, complications and outcome of the babies requiring mechanical ventilation. DESIGN: Retrospective study. SETTING: NICU of a teaching hospital. SUBJECTS: One hundred and twenty one neonates requiring assisted ventilation during three years. RESULTS: Of 121 babies 59(48.76%) survived. Hyaline membrane disease (HMD) was the commonest indication for ventilation followed by birth asphyxia, apnea of prematurity, meconium aspiration syndrome (MAS) and septicemia. Infants with HMD whose birth weight was more than 1.5 kg and those who required ventilation after 24 hours of birth had better outcome. Survival rates increased with increasing birth weight and gestational age. Prolonged ventilatory support was needed for HMD (mean 117.3 hr) and MAS (mean 82.6 hr). Pneumonia was the commonest complication, followed by sepsis, air leak syndromes and intracranial and pulmonary hemorrhage. CONCLUSIONS: Ventilatory facilities must be focussed for neonates weighing > 1000 g. Assisted ventilation may not be cost-effective in patients weighing < or = 1000 g and those with complex heart diseases and other congenital anomalies.

Custo-efetividade e custo-benefício no cuidado intensivo neonatal: atualizando informaçöes / Cost-benefit and cost-eficiency in the neonatal intensive care

Revê a literatura referente a estudos de custo-efetividade e custo-benefício no atendimento intensivo neonatal, buscando avaliar o atual estágio de informaçäo quanto à aplicaçäo destes instrumentos de análise econômica neste tipo de cuidado. Tenta compreender a utilidade e limitaçöes destes estudos na àrea em questäo