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İstanbul'da üçüncü basamak yenidoğan yoğun bakım ünitesi maliyet analizi

Yıl 2018, Cilt: 15 Sayı: 3, 116 - 124, 12.12.2018

Öz

Amaç: Perinatal ve neonatal bakım alanındaki gelişmeler, daha fazla sayıda prematüre veya riskli bebeğin yaşamasına olanak sağlamıştır. Özellikle prematüre bebekler, hastanede uzun yatış süreleri nedeniyle Yenidoğan Yoğun Bakım Ünitesi (YYBÜ)’nün doluluk oranlarını arttırmaktadır. Yenidoğan yoğun bakım hastaları, maliyet açısından hastaneye yatışların en yüksek grubunu oluşturmaktadır. Bu çalışmada, YYBÜ’ye yatan hastaların maliyetini hesaplamak ve maliyeti etkileyen faktörleri belirleyerek maliyetin azaltılması noktasında yeni hedefler belirlemeyi amaçladık.

Materyal ve Metod: Bu çalışmada 1 Ocak 2009 ile 31 Aralık 2009 tarihleri arasında YYBÜ’ye yatırılıp takip ve tedavi edilen 738 hastanın demografik özellikleri, YYBÜ’ye yatış tanıları ve bu hastalara yapılan giderler retrospektif olarak incelendi. Elde edilen verilerin maliyet analizi yapıldı.

Bulgular: Çalışmaya 738 hasta hasta alındı. Bu hastaların 398 (%53,9)’i erkek, 340 (%46,1)’ı kızdı. Maliyet açısından bakıldığında, 750-999 gram doğum ağırlığı olan bir bebek için ortalama günlük bakım maliyeti 799,16 TL, 1000-1249 g 650,76 TL, 1250-1499 g 448,30 TL, 1500-2499 g 361,64 TL, 2500-4000 g 312,55 TL, > 4000 g doğan hastalarda 308,12 TL bulundu. Gebelik Haftası (GH)’ye göre maliyet değerlendirildiğinde; GH ≤ 27 her bir bebek için ortalama günlük bakım maliyeti 805,89 TL, 28-31 GH için 534,17 TL, 32-34 GH için 400,23 TL, 35-37 GH için 385,97 TL, 38-42 GH için 302,28 TL saptandı. GH ve doğum ağırlığı arttıkça, hastanede yatış süresi ve toplam günlük ortalama maliyetlerinin azaldığı görüldü (p<0,05). Respiratuvar distres sendromu (RDS), siyanotik konjenital kalp hastalıkları (KKH), asiyanotik KKH, erken neonatal sepsis, konjenital pnömoni, yenidoğanın geçici takipnesi (YDGT), mekonyum aspirasyon sendromu (MAS), perinatal asfiksi, fetal distres tanıları alan hastaların toplam günlük ortalama maliyetlerinin yüksek olduğu görüldü (p<0,05). Çalışmamızda <1500 g altında sağ kalım oranı %81,4 ve <1000 g bebeklerin sağ kalım oranı % 36,3 saptandı. GH’sine göre özellikle ≤ 27 GH bebeklerin sağ kalım oranı % 39,5 olarak saptandı.

Sonuç: Hastanede kalış süresi ve maliyetin en güçlü belirleyici faktörlerini GH, doğum ağırlığı, RDS, fetal distres, perinatal asfiksi, asiyanotik KKH, siyanotik KKH, YDGT, erken neonatal sepsis, konjenital pnömoni ve MAS olarak saptadık. Özellikle YYBÜ’de yatırılan hastaların gebelik haftası ve doğum ağırlıkları azaldıkça, hastane yatış süresinin uzadığı ve maliyetin arttığı, hastaların sağkalım oranlarının azaldığı görüldü. Bunun sonucunda YYBÜ’nün maliyetini azaltmanın en efektif yolunun erken doğumun önlenmesi olduğu belirlendi.

Kaynakça

  • 1. U.S. Congress, Office of Technology Assessment, Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness (Health Technology Case Study 38), OTAHCS-38 (Washington, DC: U.S. Congress, Office of Technology Assessment, December 1987).
  • 2. Drummond MF, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. Oxford, England: Oxford University Press, 1986.
  • 3. Mugford M, Drummond MF. The role of economics in the evaluation of care. In Chalmers I, Enkin M, Keirse MJ, eds. Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1991: 86-96
  • 4. Asim Kurjak , Frank A. Chervenak. Textbook of Perinatal Medicine, Second Edition, volume 1,cost benefit in perinatal medicine
  • 5. Drumond MF. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996; 313: 275-283.
  • 6. Brosnan CA, Swint JM. Cost analysis: Costs and application. Public Health Nursing 2001; 18: 13-18.
  • 7. Gray JE, McCormick MC, Richardson DK, Ringer S. Normal birth weight intensive care unit survivors: outcome assessment. Pediatrics 1996;97:832- 838.
  • 8. Ringborg A, Berg J, Norman M, Westgren M, Jönsson B. Preterm birth in Sweeden: what are the average lengths of hospital stay and the associated inpatient costs? Acta Paediatr 2006;95:1550-1555.
  • 9. Russell RB, Green NS, Steiner CA, Meikle S, Howse JL, Poschman K, et all. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics 2007;120:e1-9.
  • 10. Cuevas KD, Silver DR, Brooten D, Youngblut JM, Bobo CM. The cost of prematurity: hospital charges at birth and frequency of rehospitalizations and acute care visits over the first year of life: a comparison by gestational age and birth weight. Am J Nurs. 2005 Jul;105(7):56-64.
  • 11. Engle William A, Kominiarek Michelle A. Late preterm infants, early term infants, and timing of elective deliveries. Clinics in perinatology, 2008, 35.2: 325-341.
  • 12. Ashwin Ramachandrappa and Lucky Jain. The Late Preterm Infant. Fanaroff and Martin's Neonatal-Perinatal Medicine. 9th ed. Philadelphia, PA: Mosby Elsevier, 2011, 629-32.
  • 13. U.S. Congress, Office of Technology Assessment, Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness (Health Technology Case Study 38), OTAHCS-38 (Washington, DC: U.S. Congress, Office of Technology Assessment, December 1987).
  • 14. Rogowski J. Measuring the cost of neonatal and perinatal care. Pediatrics 1999; 103 (Suppl): 329-335.
  • 15. Rosenstein AH. Fixed vs variable costs of hospital care. JAMA 1999, 18; 282: 630.
  • 16. Victorian Infant Collaborative Group. The cost of improving outcome of infants of birth weight 500–900 g in Victoria. J Paediatr Child Health 1993;29:56–62.
  • 17. Stahlman MT: Newborn intensive care: success or failure. J Pediatr 1984; 105: 162-167.
  • 18. Jacinto A, Hernandez, J'oan Offutt L, Joseph Butterfield. The cost of care of the less than 1000 gram infant, Clin Perinatol 1986; 13 (2) : 461-475.
  • 19. Powell PJ, Powell CVE, Hollis S, et al. When will my baby go home? Archives of Disease in Childhood 1992; 67: 1214-6.
  • 20. Jijon CR, Jijon Letart FX. Perinatal predictors of duration and cost of hospitalisation for premature infants. Clinical Pediatrics 1995;34(2):79–85.
  • 21. Akman İ, Cebeci D, Özek E, İmamoğlu S. Effects of perinatal factors on the duration and cost of hospitalization for premature infants at a university hospital in Istanbul. Turk J Med Sci.2002;32:159-163.
  • 22. Anil Narang, P.S Sandesh Kiran, Praveen Kumar . Cost of Neonatal Intensive Care in a Tertiary Care Center. Indian Pediatrics 2005; 42:989-997.
  • 23. Rogowski J. Cost-effectiveness of care for very low birth weight infants. Pediatrics 1998;102(1):35–43.
  • 24. Tengs TO, Adams ME, Pliskin JS, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995;15(3):369-90.
  • 25. Tyson J. Evidence based ethics and the care of premature infants .The Future of Children 1995; 5: 197-213.
  • 26. Lewit EM, Schuurmann L, Baker L, et al. The direct cost of low birth weight: Low birth weight. The Future of Children 1995; 5: 35-36.
  • 27. Hagberg B: Epidemiological and preventive aspects of cerebral palsy and severe mental retardation in Sweden. EurJPediatr 1979; 130: 71-78.
  • 28. Hack M, Fanaroff AA: Changes in the delivery room care of the extremely small infant (< 750 g): effects on morbidity and outcome. NEnglJ Med 1986; 314: 660-664.
  • 29. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et all. NICHD Neonatal Research Network. Trends in neonatal mortality and morbidity for very low birthweight infants. Am J Obstet Gynecol 2007;196:147.e1- e8. 30. Türkiye’de yenidoğan bakım ünitelerinde mortalite-2002. Türk Neonatoloji Derneği Bülteni 2005;12:10-14.
  • 31. Okulu E, Akın İ. M, Atasay B, Arsan S, Türmen T. Yenidoğan yoğun bakım ünitesinde izlenen bebeklerin gebelik haftası ve doğum ağırlıklarına göre sağkalım, hastanede yatış süreleri ve rehospitalizasyon oranları. Türkiye Çocuk Hastalıkları Dergisi 2010; 4(2).

The cost analysis of a third level neonatal intensive care unit in Istanbul

Yıl 2018, Cilt: 15 Sayı: 3, 116 - 124, 12.12.2018

Öz

Background: Developments in the field of perinatal and neonatal care have allowed a greater number of premature or risky infants to survive. Especially premature babies, because of the long length of stay in hospital Neonatal Intensive Care Unit (NICU) 's are increasing their occupancy rates. Neonatal intensive care diseases, in terms of costs constitute the largest group of hospitalization. In this study, we aimed to determine the cost of the patients in NICU, to determine the factors that affect the cost and to set new targets for what can be done to reduce the cost.

Material and Methods: The data of 738 patients who were admitted to the NICU between January 1st, 2009 and December 31st, 2009 and were followed up and treated were evaluated retrospectively. The cost analysis of all obtained data was performed.

Results: 398 (53.9%) of the 738 patients were male and 340 (46.1%) were female. In terms of cost, the average daily cost of care for a baby with a birth weight between 750-999 grams was 799.16 TL, 650.76 TL for babies 1000-1250 g, 448.30 TL for babies 1250-1499 g, 361.64 TL for babies 1500-2499 g, 312.55 TL for babies 2500-4000 g and 308.12 TL for those >4000 g. When the cost according to gestational week is evaluated; a baby with less than 28 weeks were found to be 805.89 TL, 28 to 31 weeks 534.17 TL, 32 to 36 weeks 400.23 TL, 35 to 37 weeks 385.97 TL and 38 weeks’ or longer 302.28 TL. As birth weight and gestational week increased, hospitalization time and total daily average costs decreased (p <0.05). Total daily average cost of patients with respiratory distress syndrome (RDS), cyanotic congenital heart diseases (CCHDs), acyanotic congenital heart diseases (CHDs), early neonatal sepsis, congenital pneumonia, transient tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), perinatal asphyxia and fetal distress was found to be high (p <0.05). In our study, the survival rate of infants under <1500 g was 81.4% and <1000 g was 36.3%. According to gestational week, the survival rate of less than 28 weeks infants was 39.5%.

Conclusion: We found that gestational week, birth weight, RDS, fetal distress, asphyxia, CCHDs, acyanotic CHDs, TTN, early neonatal sepsis, congenital pneumonia and MAS were the strongest determinants of hospital stay and cost. It was observed that the duration of hospital stay and cost increased and the survival rates of the patients decreased especially as the gestational week and birth weights of the patients hospitalized in the NICU decreased. As a result, the most effective way to reduce the cost of the NICU was to prevent premature birth.

Kaynakça

  • 1. U.S. Congress, Office of Technology Assessment, Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness (Health Technology Case Study 38), OTAHCS-38 (Washington, DC: U.S. Congress, Office of Technology Assessment, December 1987).
  • 2. Drummond MF, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. Oxford, England: Oxford University Press, 1986.
  • 3. Mugford M, Drummond MF. The role of economics in the evaluation of care. In Chalmers I, Enkin M, Keirse MJ, eds. Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1991: 86-96
  • 4. Asim Kurjak , Frank A. Chervenak. Textbook of Perinatal Medicine, Second Edition, volume 1,cost benefit in perinatal medicine
  • 5. Drumond MF. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996; 313: 275-283.
  • 6. Brosnan CA, Swint JM. Cost analysis: Costs and application. Public Health Nursing 2001; 18: 13-18.
  • 7. Gray JE, McCormick MC, Richardson DK, Ringer S. Normal birth weight intensive care unit survivors: outcome assessment. Pediatrics 1996;97:832- 838.
  • 8. Ringborg A, Berg J, Norman M, Westgren M, Jönsson B. Preterm birth in Sweeden: what are the average lengths of hospital stay and the associated inpatient costs? Acta Paediatr 2006;95:1550-1555.
  • 9. Russell RB, Green NS, Steiner CA, Meikle S, Howse JL, Poschman K, et all. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics 2007;120:e1-9.
  • 10. Cuevas KD, Silver DR, Brooten D, Youngblut JM, Bobo CM. The cost of prematurity: hospital charges at birth and frequency of rehospitalizations and acute care visits over the first year of life: a comparison by gestational age and birth weight. Am J Nurs. 2005 Jul;105(7):56-64.
  • 11. Engle William A, Kominiarek Michelle A. Late preterm infants, early term infants, and timing of elective deliveries. Clinics in perinatology, 2008, 35.2: 325-341.
  • 12. Ashwin Ramachandrappa and Lucky Jain. The Late Preterm Infant. Fanaroff and Martin's Neonatal-Perinatal Medicine. 9th ed. Philadelphia, PA: Mosby Elsevier, 2011, 629-32.
  • 13. U.S. Congress, Office of Technology Assessment, Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness (Health Technology Case Study 38), OTAHCS-38 (Washington, DC: U.S. Congress, Office of Technology Assessment, December 1987).
  • 14. Rogowski J. Measuring the cost of neonatal and perinatal care. Pediatrics 1999; 103 (Suppl): 329-335.
  • 15. Rosenstein AH. Fixed vs variable costs of hospital care. JAMA 1999, 18; 282: 630.
  • 16. Victorian Infant Collaborative Group. The cost of improving outcome of infants of birth weight 500–900 g in Victoria. J Paediatr Child Health 1993;29:56–62.
  • 17. Stahlman MT: Newborn intensive care: success or failure. J Pediatr 1984; 105: 162-167.
  • 18. Jacinto A, Hernandez, J'oan Offutt L, Joseph Butterfield. The cost of care of the less than 1000 gram infant, Clin Perinatol 1986; 13 (2) : 461-475.
  • 19. Powell PJ, Powell CVE, Hollis S, et al. When will my baby go home? Archives of Disease in Childhood 1992; 67: 1214-6.
  • 20. Jijon CR, Jijon Letart FX. Perinatal predictors of duration and cost of hospitalisation for premature infants. Clinical Pediatrics 1995;34(2):79–85.
  • 21. Akman İ, Cebeci D, Özek E, İmamoğlu S. Effects of perinatal factors on the duration and cost of hospitalization for premature infants at a university hospital in Istanbul. Turk J Med Sci.2002;32:159-163.
  • 22. Anil Narang, P.S Sandesh Kiran, Praveen Kumar . Cost of Neonatal Intensive Care in a Tertiary Care Center. Indian Pediatrics 2005; 42:989-997.
  • 23. Rogowski J. Cost-effectiveness of care for very low birth weight infants. Pediatrics 1998;102(1):35–43.
  • 24. Tengs TO, Adams ME, Pliskin JS, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995;15(3):369-90.
  • 25. Tyson J. Evidence based ethics and the care of premature infants .The Future of Children 1995; 5: 197-213.
  • 26. Lewit EM, Schuurmann L, Baker L, et al. The direct cost of low birth weight: Low birth weight. The Future of Children 1995; 5: 35-36.
  • 27. Hagberg B: Epidemiological and preventive aspects of cerebral palsy and severe mental retardation in Sweden. EurJPediatr 1979; 130: 71-78.
  • 28. Hack M, Fanaroff AA: Changes in the delivery room care of the extremely small infant (< 750 g): effects on morbidity and outcome. NEnglJ Med 1986; 314: 660-664.
  • 29. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et all. NICHD Neonatal Research Network. Trends in neonatal mortality and morbidity for very low birthweight infants. Am J Obstet Gynecol 2007;196:147.e1- e8. 30. Türkiye’de yenidoğan bakım ünitelerinde mortalite-2002. Türk Neonatoloji Derneği Bülteni 2005;12:10-14.
  • 31. Okulu E, Akın İ. M, Atasay B, Arsan S, Türmen T. Yenidoğan yoğun bakım ünitesinde izlenen bebeklerin gebelik haftası ve doğum ağırlıklarına göre sağkalım, hastanede yatış süreleri ve rehospitalizasyon oranları. Türkiye Çocuk Hastalıkları Dergisi 2010; 4(2).
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Mahmut Demir 0000-0002-0983-9457

Özgül Salihoğlu 0000-0002-2132-1888

Yayımlanma Tarihi 12 Aralık 2018
Gönderilme Tarihi 3 Kasım 2018
Kabul Tarihi 23 Kasım 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 15 Sayı: 3

Kaynak Göster

Vancouver Demir M, Salihoğlu Ö. İstanbul’da üçüncü basamak yenidoğan yoğun bakım ünitesi maliyet analizi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2018;15(3):116-24.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty