Cost analysis of hospitals performing continuous albuterol in non-intensive care settings

Abstract

Objective

To compare hospital costs and resource utilization for pediatric asthma admissions based on the hospitals’ availability of continuous albuterol aerosolization administration (CAA) in non-intensive care unit (ICU) settings.

Methods

We conducted a retrospective cohort study of children ages 2-17 years admitted in 2019 with a principal diagnosis of asthma using the Pediatric Health Information System. Hospitals and hospitalizations were categorized based on location of CAA administration, ICU-only versus general inpatient floors. Hospitals preforming CAA in an intermediate care unit were excluded. We calculated total cost, standardized unit costs and rates of interventions. Groups were compared using Chi-Square, t-test and Wilcoxon rank-sum test as indicated. A log linear mixed model was created to evaluate potential confounders.

Results

Twenty-one hospitals (7084 hospitalizations) allowed CAA on the floor.

Twenty-four hospitals (6100 hospitalizations) allowed CAA in the ICU-only. Median total cost was $4639 (Interquartile Range (IQR) $3060–$7512) for the floor group and $5478 (IQR $3444–$8539) for the ICU-only group (p < 0.001) (mean cost difference of $775 per patient). Hospitalization costs were $4,726,829 (95% CI $3,459,920–$5,993,860) greater for the children treated at hospitals restricting CAA to the ICU. We observed higher standardized laboratory, imaging, clinical and other unit costs, along with higher use of interventions in the ICU-only group. After adjustment, we found that ICU stay and hospital LOS were the main drivers of cost difference between the groups.

Conclusions

There was cost savings and decreased resource utilization for hospitals that performed CAA on the floor. Further studies exploring variations in asthma management are warranted.

Keywords:

• Economics
• pediatrics
• therapy
• treatment

Acknowledgements

The authors would like to thank Patti Duda of the Children’s Hospital Association and Dough MacDowell of Nationwide Children’s Hospital in their assistance in collecting the data for this project.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding

The author(s) reported there is no funding associated with the work featured in this article.