The Indian Journal of Pediatrics

, Volume 83, Issue 10, pp 1065–1070 | Cite as

Direct Cost of Critical Illness Associated Healthcare Expenditures among Children Admitted in Pediatric Intensive Care Unit in Rural India

  • Vivek V. Shukla
  • Somashekhar M. Nimbalkar
  • Jaishree D. Ganjiwale
  • Denny John
Original Article



To assess the direct costs involved in treatment of children receiving intensive care in a university-affiliated teaching hospital and its associated implications on the children’s families, in rural India.


It was a prospective observational study for cost-analysis using questionnaire based interviews and billing records data collection for admissions to the PICU over 27 consecutive months (January 2010 through March 2012).


A total of 784 children were admitted to the unit during the assessment period. Full details of 633 children were included for analysis. The average length of stay was 6.16 d, average hospital expenditure was US$185.67, average hospital expenses per day was US$44.00, average pharmacy expenditure was US$109.67 and average pharmacy expenditure per day was US$20.62 per patient. Children who were ventilated had approximately 61 % more expense per day as compared to non-ventilated ones. Boys and those with health insurance reported higher length of stay. Linear hierarchical regression with backward LR model showed that mechanical ventilation, multiple organ dysfunction, length of stay and insurance cover were the variables significantly affecting the final expenses.


There is a high direct expenditure incurred by families of children receiving intensive care when seen in perspective of high rates of extreme poverty in rural India. These high expenditures make critical care unaffordable to majority of the population lacking insurance cover in resource limited regions with limited universal health coverage, which ultimately leads to suboptimal care and high childhood mortality. It is highly imperative for the governments and global health organizations to be sensitive towards this issue and to plan strategies for the same across different nations.


Out of pocket expenditure on healthcare Pediatric critical illness Rural India Health insurance 



Authors would like to thank the participants for participation and the hospital staff for all their support in acquiring the data.


VVS: Conceptualized the study, collected data, helped in analysis, wrote the paper and approved the final manuscript; SMN: Designed the study, helped in data collection, gave critical inputs in analysis and interpretation, wrote the paper and approved the final manuscript; JDG: Analyzed the data, wrote the results and interpretation of the paper, approved the final manuscript; DJ: Helped in data analysis, wrote the paper and approved the final manuscript. SMN will act as guarantor for the paper.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding



  1. 1.
    J Pediatr Crit Care, Home page - About the journal. Available at: Accessed on 15th January 2016.
  2. 2.
    Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33:1266–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Cohen IL, Chalfin DB. Economics of mechanical ventilation: surviving the 90’s. Clin Pulm Med. 1994;1:100–7.CrossRefGoogle Scholar
  4. 4.
    Heffler S, Smith S, Keehan S, Clemens MK, Won G, Zezza M. Health spending projections for 2002–2012. Health Aff (Millwood). 2003; Suppl Web Exclusives:W3–54–65.Google Scholar
  5. 5.
    Shahrawat R, Rao KD. Insured yet vulnerable: out-of-pocket payments and India’s poor. Health Policy Plan. 2012;27:213–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Poverty reduction and equity (2010). World Bank, 2012. Available at:,,menuPK:336998~pagePK:149018~piPK:149093~theSitePK:336992,00.html. Assessed on 11 September 2012.
  7. 7.
    Gillian C, Sarah C, Terry K. Evidence-based decision-making in child health: the role of clinical research and economic evaluation. In: Wendy U, editor. Economic evaluation in child health. Oxford, New York: Oxford University Press; 2009. p. 255–70.Google Scholar
  8. 8.
    Donald SS, Jose AS. Economic evaluation of dengue prevention. In: Wendy U, editor. Economic evaluation in child health. Oxford, New York: Oxford University Press; 2009. p. 225–37.Google Scholar
  9. 9.
    Jonathan DC, Sean DS. Economic evaluations in the management of pediatric asthma. In: Wendy U, editor. Economic evaluation in child health. Oxford, New York: Oxford University Press; 2009. p. 197–209.Google Scholar
  10. 10.
    Tilford JM, Ali IR. Is more aggressive treatment of pediatric traumatic brain injury worth it. In: Wendy U, editor. Economic evaluation in child health. Oxford, New York: Oxford University Press; 2009. p. 181–96.CrossRefGoogle Scholar
  11. 11.
    Scott DG. Economic evaluations of newborn screening. In: Wendy U, editor. Economic evaluation in child health. Oxford, New York: Oxford University Press; 2009. p. 113–32.Google Scholar
  12. 12.
    Damian GW, Philippe B, Raymond H. Economic evaluation of childhood vaccines. In: Wendy U, editor. Economic evaluation in child health. Oxford, New York: Oxford University Press; 2009. p. 211–23.Google Scholar
  13. 13.
    XE Currency Charts (USD/INR), INC. Available at: Assessed on 22 May 2015.
  14. 14.
    Shukla VV, Nimbalkar SM, Phatak AG, Ganjiwale JD. Critical analysis of PIM2 score applicability in a tertiary care PICU in western India. Int J Pediatr. 2014;2014:703942.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kanter RK. Post-intensive care unit pediatric hospital stay and estimated costs. Crit Care Med. 2000;28:220–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Rapoport J, Teres D, Zhao Y, Lemeshow S. Length of stay data as a guide to hospital economic performance for ICU patients. Med Care. 2003;41:386–97.PubMedGoogle Scholar
  17. 17.
    Jacobs P, Edbrooke D, Hibbert C, Fassbender K, Corcoran M. Descriptive patient data as an explanation for the variation in average daily costs in intensive care. Anaesthesia. 2001;56:643–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Narang A, Kiran PSS, Kumar P. Cost of neonatal intensive care in a tertiary care center. Indian Pediatr. 2005;42:989–97.PubMedGoogle Scholar
  19. 19.
    Venkatnarayan K, Sankar JM, Deorari A, Krishnan A, Paul VK. A micro-costing model of neonatal intensive care from a tertiary Indian unit: feasibility and implications for insurance. Indian Pediatr. 2014;51:215–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Paul VK, Kannaraj V, Gupta S, Sarma RK. Cost of neonatal intensive care in a tertiary care hospital in New Delhi (India). Pediatr Res. 1997;41:208.Google Scholar
  21. 21.
    Per capita income in 2010–11 at Rs 54, 835. The Economic times indicators, 2011. Available at: Accessed on 14 May 2015.
  22. 22.
    Wasserfallen JB, Bossuat C, Perrin E, Cotting J. Cost borne by families of children hospitalized in a pediatric intensive care unit: a pilot study. Swiss Med Wkly. 2006;136:800–4.PubMedGoogle Scholar
  23. 23.
    Mehra P. Only 17 % have health insurance cover. Available at: Accessed on 14 May 2015.
  24. 24.
    World Bank. World development indicators, inflation and consumer prices (annual %). Available at: Assessed on 22 May, 2015.

Copyright information

© Dr. K C Chaudhuri Foundation 2016

Authors and Affiliations

  • Vivek V. Shukla
    • 1
  • Somashekhar M. Nimbalkar
    • 2
  • Jaishree D. Ganjiwale
    • 3
  • Denny John
    • 4
  1. 1.Division of NeonatologyThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of PediatricsPramukhswami Medical CollegeAnandIndia
  3. 3.Department of Community MedicinePramukhswami Medical CollegeAnandIndia
  4. 4.Department of Health EconomicsPeople’s Open Access Education InitiativeManchesterUK

Personalised recommendations