1. Costs of Care for Neonates with Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia and Validation of the Canadian Neonatal Network Costing Algorithm
- Author
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Elias Jabbour, MSc, Pia Wintermark, MD, PhD, Wijdan Basfar, MD, Sharina Patel, MD, MSc, Petros Pechlivanoglou, PhD, Prakesh Shah, MD, MSc, Marc Beltempo, MD, MSc, Prakesh S. Shah, MD, MSc, Marc Beltempo, MD, Jaideep Kanungo, MD, Joseph Ting, MD, Zenon Cieslak, MD, Rebecca Sherlock, MD, Ayman Abou Mehrem, MD, Jennifer Toye, MD, Khalid Aziz, MBBS, Carlos Fajardo, MD, Jaya Bodani, MD, Lannae Strueby, MD, Mary Seshia, MBChB, Deepak Louis, MD, Ruben Alvaro, MD, Amit Mukerji, MD, Orlando Da Silva, MD, MSc, Sajit Augustine, MD, Kyong-Soon Lee, MD, MSc, Eugene Ng, MD, Brigitte Lemyre, MD, Thierry Daboval, MD, Faiza Khurshid, MD, Victoria Bizgu, MD, Keith Barrington, MBChB, Anie Lapointe, MD, Guillaume Ethier, NNP, Christine Drolet, MD, Bruno Piedboeuf, MD, Martine Claveau, MSc, LLM, NNP, Marie St-Hilaire, MD, Valerie Bertelle, MD, Edith Masse, MD, Roderick Canning, MD, Hala Makary, MD, Cecil Ojah, MBBS, Luis Monterrosa, MD, Julie Emberley, MD, Jehier Afifi, MB, BCh, MSc, Andrzej Kajetanowicz, MD, and Shoo K. Lee, MBBS, PhD
- Subjects
Hypoxic-ischemic encephalopathy ,therapeutic hypothermia ,cost drivers ,inpatient costs ,hospital stay cost ,Pediatrics ,RJ1-570 - Abstract
Objective: Therapeutic hypothermia (TH) is the standard treatment for neonates with hypoxic-ischemic encephalopathy (HIE). Validated cost estimates are required to better evaluate the cost-effectiveness of additional interventions during TH. The goal of this study is to identify clinical factors associated with costs of care and validate the Canadian Neonatal Network (CNN) costing algorithm for neonates with HIE receiving TH. Study design: Single-center retrospective cohort study among neonates with HIE treated with TH in a tertiary neonatal intensive care unit from 2016 to 2018. Actual costs per patient were obtained from the hospital cost accounting system, Coût par Parcours de Soinset de Services, and linked to patient data. Estimated costs per patient were calculated using the CNN case-costing algorithm. Neonates were grouped into cost tertiles to identify characteristics of high resource users. Comparisons of actual costs and estimated costs were performed across 8 cost domains. Results: Among 98 neonates treated with TH, 77 (79%) had mild-moderate HIE and 21 (21%) had severe HIE on admission. Factors associated with higher costs were severity of HIE and other markers of disease severity (seizures, mechanical ventilation, length of stay, and presence of brain injury on magnetic resonance imaging). Total median cost per neonate was $24,692 [IQR: $17,466; $39,234], which highly correlated with the CNN algorithm (median: $28 558 [IQR: $23 644; $40 704]) (R = 0.93, P < .01). The mean difference in total costs between estimates was $5339 (95% CI: $2697, $7981). There was a moderate-to-strong correlation between actual and estimated costs in 5/8 cost domains (R range: 0.68-0.98). Conclusions: Severity of HIE and other markers of disease severity were associated with higher hospital costs. The CNN costing algorithm cost estimates for neonates with HIE treated with TH highly correlate with actual costs but overestimates the costs by approximately 15%.
- Published
- 2024
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