967 Direct and Indirect Financial Burden on the Families of Children Receiving Critical Care at Tertiary Level PICU in India

Abstract

Background and Aims PICU admissions result in high expenditure and impacts financial dynamics of families. We analyzed direct and indirect costs of Pediatric critical care, differences between patient groups, actual out of pocket expenditure, interventions provided and final outcomes. Methods 784 children were admitted over 27 months. 518 received discharge, 57 died, 207 discharged against medical advice & 2 absconded. 116 patients were excluded due to missing details. 668 were analyzed for Average length of stay(ALOS), average hospital expenses(AHE), average hospital expenses/day(AHED), average pharmacy expenses(APE), average pharmacy expenses/day(APED). Results ALOS in PICU was 6.125 days, AHE was $231/patient and AHED of $40/patient/day, APE was $102.3/patient & the APED was $16.7. Overall expenses were higher in younger patients especially infants. Males had more expense and length of stay. Patients who died had 4.23days(ALOS), $315(AHE), $74.5/day(AHED), $134.8(APE)& $32/day(APED); as opposed to those who were discharged 7.21days(ALOS), $224(AHE), $31.1/day(AHED), $97.9(APE)& $13.6/day(APED). Uninsured patients had 3.5 times higher expenses than insured (Analysis of expenses uncovered in insurance cover). Ventilated patients had 9.788days(ALOS), $395.2(AHE), $40.4/day(AHED), $217.5(APE)& $22.22/day(APED); compared to unventilated ones who had 4.436days(ALOS), $117.2(AHE), $26.4/day(AHED), $48.7(APE)& $11/day(APED). Patients with meningoencephalitis, multiple organ dysfunction syndrome & septicemic shock had 4, 5, 2.5 times higher expenses than average. Conclusions Younger patients and those with critical illness had higher expenditure. Intensive care life support interventions like ventilation increase the expenses to over four times average. Direct and indirect expenses incurred from critical care lead to further impoverishment of already poor classes.