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Healthcare utilization and costs of pediatric home mechanical ventilation in Canada
Author(s) -
oyama Mika L.,
Katz Sherri L.,
Amin Reshma,
McKim Douglas A.,
Guerriere Denise,
Coyte Peter C.,
Wasilewski Marina,
Zagorski Brandon,
Rose Louise
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24923
Subject(s) - medicine , interquartile range , health care , ambulatory , confidence interval , observational study , demography , emergency medicine , surgery , pathology , sociology , economics , economic growth
Background Children using home mechanical ventilation (HMV) live at home with better quality of life, despite financial burden for their family. Previous studies of healthcare utilization and costs have not considered public and private expenditures, including family caregiver time. Our objective was to examine public and private healthcare utilization and costs for children using HMV, and variables associated with highest costs. Methods Longitudinal, prospective, observational cost analysis study (2012‐2014) collecting data on public and private (out‐of‐pocket, third‐party insurance, and caregiving) costs every 2 weeks for 6 months using the Ambulatory Home Care Record. Functional Independence Measure (FIM), WeeFIM, and Caregiving Impact Scale (CIS) were measured at baseline and study completion. Regression modeling examined a priori selected variables associated with monthly costs using Andersen and Newman's framework for healthcare utilization, relevant literature, and clinical expertise. Data are reported in 2015 Canadian dollars ($1CAD = $0.78USD). Results Forty two children and their caregivers were enrolled. Overall median (interquartile range) monthly healthcare cost was $12 131 ($8159‐$15 958) comprising $9929 (89%) family caregiving hours, $996 (9%) publicly funded, and $252 (2%) out‐of‐pocket (<1% third‐party insurance) costs. With higher FIM score (lower dependency), median costs were reduced by 4.5% (95% confidence interval: 8.3%‐0.5%), adjusted for age, sex, tracheostomy, and daily ventilation duration. Note: since the three cost categories did not sum to the total statistically derived median cost, the percentage of each category used the sum of median public + caregiver lost time + private out‐of‐pocket + third‐party insurance as the denominator. Conclusions For HMV children, most healthcare costs were due to family caregiving costs. More dependent children incur highest costs. The financial burden to family caregivers is substantial and needs to considered in future policy decisions related to pediatric HMV.