Household economic burden of childhood severe pneumonia in Bangladesh: a cost-of-illness study

Marufa Sultana, Nur H Alam, Nausad Ali, A S G Faruque, George J Fuchs, Niklaus Gyr, Md Jobayer Chisti, Tahmeed Ahmed, Lisa Gold, Marufa Sultana, Nur H Alam, Nausad Ali, A S G Faruque, George J Fuchs, Niklaus Gyr, Md Jobayer Chisti, Tahmeed Ahmed, Lisa Gold

Abstract

Objective: To estimate household cost of illness (COI) for children with severe pneumonia in Bangladesh.

Design: An incidence-based COI study was performed for one episode of childhood severe pneumonia from a household perspective. Face-to-face interviews collected data on socioeconomic, resource use and cost from caregivers. A micro-costing bottom-up approach was applied to calculate medical, non-medical and time costs. Multiple regression analysis was applied to explore the factors associated with COI. Sensitivity analysis explored the robustness of cost parameters.

Setting: Four urban and rural study sites from two districts in Bangladesh.

Patients: Children aged 2-59 months with severe pneumonia.

Results: 1472 children with severe pneumonia were enrolled between November 2015 and March 2019. The mean age of children was 12 months (SD ±10.2) and 64% were male. The mean household cost per episode was US$147 (95% CI 141.1 to 152.7). Indirect costs were the main cost drivers (65%, US$96). Household costs for the poorest income quintile were lower in absolute terms, but formed a higher proportion of monthly income. COI was significantly higher if treatment was received from urban health facilities compared with rural health facilities (difference US$84.9, 95% CI 73.3 to 96.3). Child age, household income, healthcare facility and hospital length of stay (LoS) were significant predictors of household COI. Costs were most sensitive to hospital LoS and productivity loss.

Conclusions: Severe pneumonia in young children is associated with high household economic burden and cost varies significantly across socioeconomic parameters. Management strategies with improved accessibility are needed particularly for the poor to make treatment affordable in order to reduce household economic burden.

Keywords: health services research; statistics.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Distribution of mean household cost per episode of childhood severe pneumonia by wealth quintiles.
Figure 2
Figure 2
Tornado diagram of one-way sensitivity analysis using important cost parameters. Each bar represents the influence of variation on each parameter in relation to the base case results through the vertical line in the middle, with the most cost-sensitive parameters arranged from top to bottom. LoS, length of stay.

References

    1. UNICEF . One is too many: ending child deaths from pneumonia and diarrhoea. New York, NY 10017, USA, 2016.
    1. Liu L, Oza S, Hogan D, et al. . Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the sustainable development goals. Lancet 2016;17:3027–35. 10.1016/S0140-6736(16)31593-8
    1. International Vaccine Access Center (IVAC) . Pneumonia & Diarrhea Progress Report 2015: Sustainable Progress in the Post-2015 Era. USA: Johns Hopkins Bloomberg School of Public Health, 2015: 1–42.
    1. McAllister DA, Liu L, Shi T, et al. . Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Glob Health 2019;7:e47–57. 10.1016/S2214-109X(18)30408-X
    1. Rudan I, Boschi-Pinto C, Biloglav Z, et al. . Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008;86:408–16. 10.2471/blt.07.048769
    1. Walker CLF, Rudan I, Liu L, et al. . Global burden of childhood pneumonia and diarrhoea. Lancet 2013;381:1405–16. 10.1016/S0140-6736(13)60222-6
    1. Chisti MJ, Salam MA, Smith JH, et al. . Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial. Lancet 2015;386:1057–65. 10.1016/S0140-6736(15)60249-5
    1. World Health Organization . Pocket Book of Hospital Care for Children - Guidelines for the Management of Common Child-hood Illnesses. 2nd edition. Geneva, 2013.
    1. Lozano R, Naghavi M, Foreman K, et al. . Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2095–128. 10.1016/S0140-6736(12)61728-0
    1. UNICEF . Pneumonia. Available: [Accessed 2 Mar 2020].
    1. National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF Inter- national . Bangladesh Demographic and Health Survey 2014: Key Indicators. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International, 2015.
    1. Zhang S, Sammon PM, King I, et al. . Cost of management of severe pneumonia in young children: systematic analysis. J Glob Health 2016;6:010408. 10.7189/jogh.06.010408
    1. Usuf E, Mackenzie G, Sambou S, et al. . The economic burden of childhood pneumococcal diseases in the Gambia. Cost Eff Resour Alloc 2016;14:4. 10.1186/s12962-016-0053-4
    1. Sultana M, Sarker AR, Sheikh N, et al. . Prevalence, determinants and health care-seeking behavior of childhood acute respiratory tract infections in Bangladesh. PLoS One 2019;14:e0210433. 10.1371/journal.pone.0210433
    1. Sarker AR, Sultana M, Mahumud RA, et al. . Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective. Glob Health Res Policy 2018;3:1. 10.1186/s41256-017-0056-5
    1. Sarker AR, Islam Z, Khan IA, et al. . Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective. BMC Infect Dis 2013;13:518. 10.1186/1471-2334-13-518
    1. Tahsina T, Ali NB, Siddique MAB, et al. . Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh. PLoS One 2018;13:e0196237. 10.1371/journal.pone.0196237
    1. Halder AK, Luby SP, Akhter S, et al. . Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh. Am J Trop Med Hyg 2017;96:953–60. 10.4269/ajtmh.16-0005
    1. Ashraf H, Mahmud R, Alam NH, et al. . Randomized controlled trial of day care versus hospital care of severe pneumonia in Bangladesh. Pediatrics 2010;126:e807–15. 10.1542/peds.2009-3631
    1. Alamgir NI, Naheed A, Luby SP. Coping strategies for financial burdens in families with childhood pneumonia in Bangladesh. BMC Public Health 2010;10:622. 10.1186/1471-2458-10-622
    1. Drummond MF, Sculpher MJ, Claxton K. Methods for the economic evaluation of health care programmes. 4th edn. Newyork: Oxford University Press, 2015.
    1. Xie F, Thumboo J, Fong K-Y, et al. . A study on indirect and intangible costs for patients with knee osteoarthritis in Singapore. Value Health 2008;11:S84–90. 10.1111/j.1524-4733.2008.00371.x
    1. Memirie ST, Metaferia ZS, Norheim OF, et al. . Household expenditures on pneumonia and diarrhoea treatment in Ethiopia: a facility-based study. BMJ Glob Health 2017;2:e000166. 10.1136/bmjgh-2016-000166
    1. Javanbakht M, Baradaran HR, Mashayekhi A, et al. . Cost-Of-Illness analysis of type 2 diabetes mellitus in Iran. PLoS One 2011;6:e26864. 10.1371/journal.pone.0026864
    1. Gao L, Xia L, Pan S-Q, et al. . Burden of epilepsy: a prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy. Epilepsy Res 2015;110:146–56. 10.1016/j.eplepsyres.2014.12.001
    1. Briggs A, Clark T, Wolstenholme J, et al. . Missing. presumed at random: cost-analysis of incomplete data. Health Econ 2003;12:377–92. 10.1002/hec.766
    1. Madsen HO, Hanehøj M, Das AR, et al. . Costing of severe pneumonia in hospitalized infants and children aged 2-36 months, at a secondary and tertiary level hospital of a not-for-profit organization. Trop Med Int Health 2009;14:1315–22. 10.1111/j.1365-3156.2009.02374.x
    1. Hussain H, Waters H, Khan AJ, et al. . Economic analysis of childhood pneumonia in northern Pakistan. Health Policy Plan 2008;23:438–42. 10.1093/heapol/czn033
    1. Ashraf H, Alam NH, Sultana M, et al. . Day clinic vs. hospital care of pneumonia and severe malnutrition in children under five: a randomised trial. Trop Med Int Health 2019;24:922–31. 10.1111/tmi.13242
    1. Anh DD, Riewpaiboon A, Tho LH, et al. . Treatment costs of pneumonia, meningitis, sepsis, and other diseases among hospitalized children in Viet Nam. J Health Popul Nutr 2010;28:436–42. 10.3329/jhpn.v28i5.6151
    1. Ayieko P, Akumu AO, Griffiths UK, et al. . The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis. Cost Eff Resour Alloc 2009;7:3. 10.1186/1478-7547-7-3
    1. Khuri-Bulos N, Williams JV, Shehabi AA, et al. . Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan. Scand J Infect Dis 2010;42:368–74. 10.3109/00365540903496544
    1. Saha L, Kaur S, Khosla P. Pharmacoeconomic analysis of drugs used in the treatment of pneumonia in paediatric population in a tertiary care hospital in India-A cost-of-illness study. Medical sciences 2017;5:33.
    1. Hussain H, Waters H, Omer SB, et al. . The cost of treatment for child pneumonias and meningitis in the Northern areas of Pakistan. Int J Health Plann Manage 2006;21:229–38. 10.1002/hpm.847
    1. Chola L, Robberstad B. Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia. Cost Eff Resour Alloc 2009;7:16. 10.1186/1478-7547-7-16
    1. World Health Organization . Distribution of health payments and catastrophic expenditures methodology / by Ke Xu. World Health organization, 2005. Available:
    1. Joarder T, Chaudhury TZ, Mannan I. Universal health coverage in Bangladesh: activities, challenges, and suggestions. Psyche 2019;2019:4954095. 10.1155/2019/4954095
    1. Ehlken B, Ihorst G, Lippert B, et al. . Economic impact of community-acquired and nosocomial lower respiratory tract infections in young children in Germany. Eur J Pediatr 2005;164:607–15. 10.1007/s00431-005-1705-0
    1. Deressa W, Hailemariam D, Ali A. Economic costs of epidemic malaria to households in rural Ethiopia. Trop Med Int Health 2007;12:1148–56. 10.1111/j.1365-3156.2007.01901.x
    1. Attanayake N, Fox-Rushby J, Mills A. Household costs of 'malaria' morbidity: a study in Matale district, Sri Lanka. Trop Med Int Health 2000;5:595–606. 10.1046/j.1365-3156.2000.00612.x
    1. Uranw S, Meheus F, Baltussen R, et al. . The household costs of visceral leishmaniasis care in south-eastern Nepal. PLoS Negl Trop Dis 2013;7:e2062. 10.1371/journal.pntd.0002062
    1. Sarker AR, Akram R, Ali N, et al. . Coverage and factors associated with full immunisation among children aged 12-59 months in Bangladesh: insights from the nationwide cross-sectional demographic and health survey. BMJ Open 2019;9:e028020. 10.1136/bmjopen-2018-028020
    1. Alvis-Guzman N, Orozco-Africano J, Paternina-Caicedo A, et al. . Treatment costs of diarrheal disease and all-cause pneumonia among children under-5 years of age in Colombia. Vaccine 2013;31:C58–62. 10.1016/j.vaccine.2013.05.035
    1. Mahumud RA, Sarker AR, Sultana M, et al. . Distribution and determinants of out-of-pocket healthcare expenditures in Bangladesh. J Prev Med Public Health 2017;50:91–9. 10.3961/jpmph.16.089

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