Advertisement

Indian Pediatrics

, Volume 50, Issue 9, pp 839–846 | Cite as

Cost of neonatal intensive care delivered through district level public hospitals in India

  • Shankar PrinjaEmail author
  • Neha Manchanda
  • Pavitra Mohan
  • Gagan Gupta
  • Ghanashyam Sethy
  • Ashish Sen
  • Henri van den Hombergh
  • Rajesh Kumar
Research Paper

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.

Keywords

Child health Costing Economic evaluation SCNU Neonatal intensive care 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ved RR, Dua AS. Review of women and children’s health in India: Focus on safe motherhood: NCMH Background Papers — Burden of Disease in India2005.Google Scholar
  2. 2.
    Neogi SB, Malhotra S, Zodpey S, Mohan P. Assessment of special care newborn units in India. J Health Popul Nutr. 2011;29:500–509.PubMedCrossRefGoogle Scholar
  3. 3.
    MOHFW. Brief Note on Child Health. New Delhi: Ministry of Health and Family Welfare. Government of India. Accessed from http://mohfw.nic.in/NRHM/Documents/Brief_Note_on_CH_Nov_2011.pdf on 30 Dec 2011; 2011.Google Scholar
  4. 4.
    Zupancic J, Richardson D, O’Brien B, Schmidt B, MC W. Daily cost prediction model in neonatal intensive care. Int J Tech Ass Health Care. 2003;19:330–338.CrossRefGoogle Scholar
  5. 5.
    Neonatal intensive care for low birth weight infants: Costs and effectiveness (Health Technology Case Study 38). Washington D.C: Office of Technology Assessment 1987.Google Scholar
  6. 6.
    Mendelsohn AS, Asirvatham JR, Mwamburi DM, TV S, Malik V, J M, et al. Estimates of the economic burden of rotavirus-associated and all-cause diarrhoea in Vellore, India. Tropical Medicine and International Health. 2008;13:934–942.PubMedCrossRefGoogle Scholar
  7. 7.
    Sur D, Chatterjee S, Riewpaiboon A, Manna B, Kanungo S, Bhattacharya SK. Treatment Cost for Typhoid Fever at Two Hospitals in Kolkata, India. Health Popul Nutr 2009;27:725–732.Google Scholar
  8. 8.
    Narang A, Kiran PS, P K. Cost of Neonatal Intensive Care in a Tertiary Care Cente. Indian Pediatrics. 2005;42: 989–997.PubMedGoogle Scholar
  9. 9.
    Shanmugasundaram R, Padmapriya E, Shyamala J. Cost of neonatal intensive care. Indian J Pediatr. 1998;65: 249–255.PubMedCrossRefGoogle Scholar
  10. 10.
    Drummond ME, Stoddard GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. First ed: Oxford University Press; 1987.Google Scholar
  11. 11.
    UNICEF. Price List for SCNU Equipments. New Delhi: UNICEF; 2008. p. 1–26.Google Scholar
  12. 12.
    MOHFW. List of Haryana Package Rates for Approved Hospitals. Chandigarh: Haryana Health Department 2010.Google Scholar
  13. 13.
    Adam T, Manzi F, Kadundwa C, Schellenberg J, Mgalula L, de Savigny D, et al. Multi-country evaluation of the integrated management of childhood illnesses (IMCI). Analysis report of the costs of IMCI in Tanzania. Geneva: Department of Child And Adolescent Health and Development, World Health Organisation. 2004.Google Scholar
  14. 14.
    Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, DB E, et al. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva, Switzerland 2003.Google Scholar
  15. 15.
    Drummond M. E, Stoddard GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. First ed: Oxford University Press; 1987.Google Scholar
  16. 16.
    X-Rates. 2010 — Indian Rupees to 1 USD (invert). Accessed from http://www.x-rates.com/d/INR/USD/hist2010.html on 1 July 2012. 2010.
  17. 17.
    Doubilet P, Begg CB, Weinstein MC, Braun P, BJ. M, Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Medical Decision Making. 1985;5:157–177.CrossRefGoogle Scholar
  18. 18.
    Kotwani A, Ewen M, Dey D, Iyer S, Lakshmi PK, Patel A, et al. Prices & availability of common medicines at six sites in India using a standard methodology. Indian J Med Res. 2007;125:645–654.PubMedGoogle Scholar
  19. 19.
    Draft National Pharmaceuticals Pricing Policy, (NPPP 2011) 2011.Google Scholar
  20. 20.
    CIMS Updated Prescriber’s Handbook. CMP Medica India. 2006.Google Scholar
  21. 21.
    Prinja S, Bahuguna P, Pinto AD, Sharma A, Bharaj G, Kumar V, et al. The cost of universal health care in India: a model based estimate. PLoS One. 2012;7:e30362.PubMedCrossRefGoogle Scholar
  22. 22.
    Geitona M, Hatzikou M, Hatzistamatiou Z, Anastasiadou A, Theodoratou TD. The economic burden of treating neonates in Intensive Care Units (ICUs) in Greece. Cost Eff Resour Alloc. 2007;5:9.PubMedCrossRefGoogle Scholar
  23. 23.
    Cheah IG, Soosai AP, Wong SL, Lim TO, Cost-Effectiveness NSG. Cost-effectiveness analysis of Malaysian neonatal intensive care units. J Perinatol. [Multicenter Study]. 2005;25:47–53.PubMedCrossRefGoogle Scholar
  24. 24.
    MOHFW. National Health Policy 2002. New Delhi: Ministry of Health and Family Welfare, Government of India 2002.Google Scholar
  25. 25.
    Vaizey J, Oppe TE. Study of special-care baby services in North-west Thames region. Br Med J 1979;1:583–585.PubMedCrossRefGoogle Scholar
  26. 26.
    Mukasa GK. Morbidity and mortality in Special Care Unit of New Mulago Hospital, Kampala. Ann Trop Pediatr. 1992;12:289–295.Google Scholar
  27. 27.
    Gessner B, PT M. Perinatal care regionalization and low birth weight infant mortality rates in Alaska. Am J Obstet Gynecol. 2001;185:623–628.PubMedCrossRefGoogle Scholar
  28. 28.
    Subramaniam C, Clark-Prakash C, Dadina Z, Ferrara B, Honson D. Intensive care for high risk infants in Calcutta. Efficacy and cost. Am J Dis Child. 1992;140:885–888.Google Scholar
  29. 29.
    Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence. Pediatrics. 2005 February 1, 2005;115:519–617.Google Scholar
  30. 30.
    Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. [Comparative Study Research Support, Non-U.S. Gov’t]. 1999;354:1955–1961.PubMedGoogle Scholar
  31. 31.
    Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L. Evidence-based, cost-effective interventions: how many newborn babies can we save? The Lancet. 2005;365:977–988.CrossRefGoogle Scholar
  32. 32.
    Profit J, Lee D, Zupancic JA, Papile L, Gutierrez C, Goldie SJ, et al. Clinical benefits, costs, and costeffectiveness of neonatal intensive care in Mexico. PLoS Med. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. 2010;7:e1000379.PubMedGoogle Scholar
  33. 33.
    Stolz JW, McCormick MC. Restricting access to neonatal intensive care: effect on mortality and economic savings. Pediatrics. [Comparative Study Research Support, U.S. Gov’t, P.H.S.]. 1998;101:344–348.PubMedGoogle Scholar
  34. 34.
    Rogowski J. Cost-effectiveness of care for very low birth weight infants Pediatrics. 1998;102:35–43.Google Scholar
  35. 35.
    Doyle LW, Victorian Infant Collaborative Study G. Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency. Pediatrics. [Research Support, Non-U.S. Gov’t]. 2004;113:510–514.Google Scholar
  36. 36.
    NSSO. Morbidity, Health Care and the Condition of the Aged. NSS 60th Round Report No. 507 (60/25.0/1). New Delhi: National Sample Survey Organization, Ministry of Statistics and Programme Implementation 2006.Google Scholar
  37. 37.
    Prinja S, Kanavos P, Kumar R. Health care inequities in north India: Role of public sector in universalizing health care. Indian J Med Res. 2012;136:421–431.PubMedGoogle Scholar
  38. 38.
    Prinja S, Aggarwal AK, Kumar R, Kanavos P. User charges in health care: effect on service utilization and equity in Haryana. Indian J Med Res. 2012;136:868–872.PubMedGoogle Scholar
  39. 39.
    Garg C, Karan A. Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India. Health Policy Plan. 2009;24:116–128.PubMedCrossRefGoogle Scholar
  40. 40.
    Vaishnavi SD, Dash U. Catastrophic payments for health care among households in urban Tamil Nadu, India. Journal of International Development. 2009;21:169–184.CrossRefGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2013

Authors and Affiliations

  • Shankar Prinja
    • 1
    • 6
    Email author
  • Neha Manchanda
    • 1
  • Pavitra Mohan
    • 2
  • Gagan Gupta
    • 3
  • Ghanashyam Sethy
    • 4
  • Ashish Sen
    • 5
  • Henri van den Hombergh
    • 2
  • Rajesh Kumar
    • 1
  1. 1.School of Public HealthPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.UNICEF India Country OfficeNew DelhiIndia
  3. 3.UNICEF, E-7/650 Arera ColonyShahpura, BhopalIndia
  4. 4.UNICEF, UNICEF Office for BiharPatnaIndia
  5. 5.UNICEF Field Office for OrissaBhubaneswarIndia
  6. 6.School of Public HealthPost Graduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations