OBJECTIVES

Severe pneumonia is the leading and single largest cause of death among under-five children particularly in developing countries. The objective of this study was to estimate the provider costs for management of severe pneumonia and to assess rural-urban costs variation as well as costs across types of facilities.

METHODS

: This study was nested in a cluster randomized trial that was conducted by icddr,b in Bangladesh. Children diagnosed with severe pneumonia were enrolled in the study from November 2015 to February 2019. A bottom-up micro-costing approach was applied to collect most detailed data at patient level from each of the study sites (n=16). Equivalent annual costs were calculated for capital items (building, vehicles, equipment). Recurrent costs and shared costs were collected and measured accordingly. All costs were converted to US dollar (USD) using 2019 price year (1 USD = 84.5 BDT). and Descriptive analysis and log linear regression were employed to analyse data.

RESULTS

: A total of 1,480 hospitalised children were treated in 16 facilities. Average length of stay (LoS) was 5.0 days (SD±2.6). Average cost per patient to manage one episode of severe pneumonia was US$ 42. Breakdown of the costs showed that personnel costs (paediatrician, physician, nurse and others) was the major cost driver that contributed to 47% of the total provider costs followed by costs of medicine (12%). Costs was higher in urban facilities (US$ 59.6) compared to rural (US$ 37.4). Considering type of facilities, cost was higher for specialised/autonomous hotels (US$ 47) compared to upazila level hospitals (US$ 15). Regression analysis showed that costs are significantly associated with LoS and age of the children (p<0.0001).

CONCLUSIONS

: Severe pneumonia management associated with a substantial amount of resources usage, mainly driven by personnel cost. Case prevention through vaccination and low cost culturally acceptable new management strategies are recommended to reduce the burden.