Cost of management of severe pneumonia in young children: systematic analysis
Identifieur interne : 000555 ( Pmc/Curation ); précédent : 000554; suivant : 000556Cost of management of severe pneumonia in young children: systematic analysis
Auteurs : Shanshan Zhang [Royaume-Uni, République populaire de Chine] ; Peter M. Sammon [Royaume-Uni] ; Isobel King [Royaume-Uni] ; Ana Lucia Andrade [Brésil] ; Cristiana M. Toscano [Brésil] ; Sheila N. Araujo [Brésil] ; Anushua Sinha ; Shabir A. Madhi [Afrique du Sud] ; Gulam Khandaker [Australie] ; Jiehui Kevin Yin [Australie] ; Robert Booy [Australie] ; Tanvir M. Huda [Bangladesh, Australie] ; Qazi S. Rahman [Bangladesh] ; Shams El Arifeen [Bangladesh] ; Angela Gentile [Argentine] ; Norberto Giglio [Argentine] ; Mejbah U. Bhuiyan [Bangladesh] ; Katharine Sturm Amirez [Bangladesh, États-Unis] ; Bradford D. Gessner [France] ; Mardiati Nadjib [Indonésie] ; Phyllis J. Carosone Ink [États-Unis] ; Eric Af Sim Es [États-Unis] ; Jason A. Child [États-Unis] ; Imran Ahmed [Pakistan] ; Zulfiqar A. Bhutta [Pakistan] ; Sajid B. Soofi [Pakistan] ; Rumana J. Khan [Bangladesh] ; Harry Campbell [Royaume-Uni] ; Harish Nair [Royaume-Uni, Inde]Source :
- Journal of Global Health [ 2047-2978 ] ; ????.
Abstract
Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.
We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate.
We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low– and–middle income countries (LMIC) and high–income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5–8.7), US$ 51.7 (95% CI 17.4–91.0) and US$ 242.7 (95% CI 153.6–341.4)–559.4 (95% CI 268.9–886.3) in community, out–patient facilities and different levels of hospital in–patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%–115.8% of patients’ monthly household income in LMIC. The mean direct non–medical cost and indirect cost for severe pneumonia management accounted for 0.5–31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3–6.4) and 7.7 (IQR 5.5–9.9) days in LMIC and HIC respectively for these children.
This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.
Url:
DOI: 10.7189/jogh.06.010408
PubMed: 27231544
PubMed Central: 4871066
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Anushua Sinha<affiliation><nlm:aff id="aff6">New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA</nlm:aff>
<wicri:noCountry code="subfield">New Jersey USA</wicri:noCountry>
</affiliation>
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<wicri:regionArea>Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO</wicri:regionArea>
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<affiliation wicri:level="1"><nlm:aff id="aff18">Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO</wicri:regionArea>
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<affiliation wicri:level="1"><nlm:aff id="aff19">Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA</nlm:aff>
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<author><name sortKey="Child, Jason A" sort="Child, Jason A" uniqKey="Child J" first="Jason A" last="Child">Jason A. Child</name>
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<author><name sortKey="Ahmed, Imran" sort="Ahmed, Imran" uniqKey="Ahmed I" first="Imran" last="Ahmed">Imran Ahmed</name>
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<author><name sortKey="Bhutta, Zulfiqar A" sort="Bhutta, Zulfiqar A" uniqKey="Bhutta Z" first="Zulfiqar A" last="Bhutta">Zulfiqar A. Bhutta</name>
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<author><name sortKey="Khan, Rumana J" sort="Khan, Rumana J" uniqKey="Khan R" first="Rumana J" last="Khan">Rumana J. Khan</name>
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<author><name sortKey="Campbell, Harry" sort="Campbell, Harry" uniqKey="Campbell H" first="Harry" last="Campbell">Harry Campbell</name>
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<author><name sortKey="Nair, Harish" sort="Nair, Harish" uniqKey="Nair H" first="Harish" last="Nair">Harish Nair</name>
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<affiliation wicri:level="1"><nlm:aff id="aff24">Public Health Foundation of India, New Delhi, India</nlm:aff>
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<author><name sortKey="Andrade, Ana Lucia" sort="Andrade, Ana Lucia" uniqKey="Andrade A" first="Ana Lucia" last="Andrade">Ana Lucia Andrade</name>
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<author><name sortKey="Toscano, Cristiana M" sort="Toscano, Cristiana M" uniqKey="Toscano C" first="Cristiana M." last="Toscano">Cristiana M. Toscano</name>
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</affiliation>
</author>
<author><name sortKey="Araujo, Sheila N" sort="Araujo, Sheila N" uniqKey="Araujo S" first="Sheila N" last="Araujo">Sheila N. Araujo</name>
<affiliation wicri:level="1"><nlm:aff id="aff4">Department of Community Health, Federal University of Goias, Brazil</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>Department of Community Health, Federal University of Goias</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff5">State University of Maranhăo, Brazil</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>State University of Maranhăo</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Sinha, Anushua" sort="Sinha, Anushua" uniqKey="Sinha A" first="Anushua" last="Sinha">Anushua Sinha</name>
<affiliation><nlm:aff id="aff6">New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA</nlm:aff>
<wicri:noCountry code="subfield">New Jersey USA</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Madhi, Shabir A" sort="Madhi, Shabir A" uniqKey="Madhi S" first="Shabir A." last="Madhi">Shabir A. Madhi</name>
<affiliation wicri:level="1"><nlm:aff id="aff7">Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff8">Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Khandaker, Gulam" sort="Khandaker, Gulam" uniqKey="Khandaker G" first="Gulam" last="Khandaker">Gulam Khandaker</name>
<affiliation wicri:level="1"><nlm:aff id="aff9">National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff10">Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Yin, Jiehui Kevin" sort="Yin, Jiehui Kevin" uniqKey="Yin J" first="Jiehui Kevin" last="Yin">Jiehui Kevin Yin</name>
<affiliation wicri:level="1"><nlm:aff id="aff9">National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff10">Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Booy, Robert" sort="Booy, Robert" uniqKey="Booy R" first="Robert" last="Booy">Robert Booy</name>
<affiliation wicri:level="1"><nlm:aff id="aff9">National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff10">Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Huda, Tanvir M" sort="Huda, Tanvir M" uniqKey="Huda T" first="Tanvir M" last="Huda">Tanvir M. Huda</name>
<affiliation wicri:level="1"><nlm:aff id="aff11">Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh</nlm:aff>
<country xml:lang="fr">Bangladesh</country>
<wicri:regionArea>Centre for Child and Adolescent Health, icddr,b, Dhaka</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff12">School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>School of Public Health, Sydney Medical School, University of Sydney, Sydney</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Rahman, Qazi S" sort="Rahman, Qazi S" uniqKey="Rahman Q" first="Qazi S" last="Rahman">Qazi S. Rahman</name>
<affiliation wicri:level="1"><nlm:aff id="aff11">Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh</nlm:aff>
<country xml:lang="fr">Bangladesh</country>
<wicri:regionArea>Centre for Child and Adolescent Health, icddr,b, Dhaka</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="El Arifeen, Shams" sort="El Arifeen, Shams" uniqKey="El Arifeen S" first="Shams" last="El Arifeen">Shams El Arifeen</name>
<affiliation wicri:level="1"><nlm:aff id="aff11">Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh</nlm:aff>
<country xml:lang="fr">Bangladesh</country>
<wicri:regionArea>Centre for Child and Adolescent Health, icddr,b, Dhaka</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Gentile, Angela" sort="Gentile, Angela" uniqKey="Gentile A" first="Angela" last="Gentile">Angela Gentile</name>
<affiliation wicri:level="1"><nlm:aff id="aff13">Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina</nlm:aff>
<country xml:lang="fr">Argentine</country>
<wicri:regionArea>Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Giglio, Norberto" sort="Giglio, Norberto" uniqKey="Giglio N" first="Norberto" last="Giglio">Norberto Giglio</name>
<affiliation wicri:level="1"><nlm:aff id="aff13">Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina</nlm:aff>
<country xml:lang="fr">Argentine</country>
<wicri:regionArea>Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Bhuiyan, Mejbah U" sort="Bhuiyan, Mejbah U" uniqKey="Bhuiyan M" first="Mejbah U." last="Bhuiyan">Mejbah U. Bhuiyan</name>
<affiliation wicri:level="1"><nlm:aff id="aff14">Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh</nlm:aff>
<country xml:lang="fr">Bangladesh</country>
<wicri:regionArea>Centre for Communicable Diseases, icddr,b, Dhaka</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Sturm Amirez, Katharine" sort="Sturm Amirez, Katharine" uniqKey="Sturm Amirez K" first="Katharine" last="Sturm Amirez">Katharine Sturm Amirez</name>
<affiliation wicri:level="1"><nlm:aff id="aff14">Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh</nlm:aff>
<country xml:lang="fr">Bangladesh</country>
<wicri:regionArea>Centre for Communicable Diseases, icddr,b, Dhaka</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff15">Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Gessner, Bradford D" sort="Gessner, Bradford D" uniqKey="Gessner B" first="Bradford D." last="Gessner">Bradford D. Gessner</name>
<affiliation wicri:level="1"><nlm:aff id="aff16">Agence de Médicine Préventive, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Agence de Médicine Préventive, Paris</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Nadjib, Mardiati" sort="Nadjib, Mardiati" uniqKey="Nadjib M" first="Mardiati" last="Nadjib">Mardiati Nadjib</name>
<affiliation wicri:level="1"><nlm:aff id="aff17">Faculty of Public Health, University of Indonesia, Jakarta, Indonesia</nlm:aff>
<country xml:lang="fr">Indonésie</country>
<wicri:regionArea>Faculty of Public Health, University of Indonesia, Jakarta</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Carosone Ink, Phyllis J" sort="Carosone Ink, Phyllis J" uniqKey="Carosone Ink P" first="Phyllis J." last="Carosone Ink">Phyllis J. Carosone Ink</name>
<affiliation wicri:level="1"><nlm:aff id="aff18">Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Sim Es, Eric Af" sort="Sim Es, Eric Af" uniqKey="Sim Es E" first="Eric Af" last="Sim Es">Eric Af Sim Es</name>
<affiliation wicri:level="1"><nlm:aff id="aff18">Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff19">Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Child, Jason A" sort="Child, Jason A" uniqKey="Child J" first="Jason A" last="Child">Jason A. Child</name>
<affiliation wicri:level="1"><nlm:aff id="aff20">Pharmacy Department, Children's Hospital Colorado, Aurora, CO, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Pharmacy Department, Children's Hospital Colorado, Aurora, CO</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Ahmed, Imran" sort="Ahmed, Imran" uniqKey="Ahmed I" first="Imran" last="Ahmed">Imran Ahmed</name>
<affiliation wicri:level="1"><nlm:aff id="aff21">Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan</nlm:aff>
<country xml:lang="fr">Pakistan</country>
<wicri:regionArea>Center of Excellence in Women and Child Health, the Aga Khan University, Karachi</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Bhutta, Zulfiqar A" sort="Bhutta, Zulfiqar A" uniqKey="Bhutta Z" first="Zulfiqar A" last="Bhutta">Zulfiqar A. Bhutta</name>
<affiliation wicri:level="1"><nlm:aff id="aff21">Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan</nlm:aff>
<country xml:lang="fr">Pakistan</country>
<wicri:regionArea>Center of Excellence in Women and Child Health, the Aga Khan University, Karachi</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Soofi, Sajid B" sort="Soofi, Sajid B" uniqKey="Soofi S" first="Sajid B" last="Soofi">Sajid B. Soofi</name>
<affiliation wicri:level="1"><nlm:aff id="aff22">Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan</nlm:aff>
<country xml:lang="fr">Pakistan</country>
<wicri:regionArea>Department of Paediatrics & Child Health, The Aga Khan University, Karachi</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Khan, Rumana J" sort="Khan, Rumana J" uniqKey="Khan R" first="Rumana J" last="Khan">Rumana J. Khan</name>
<affiliation wicri:level="1"><nlm:aff id="aff23">James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh</nlm:aff>
<country xml:lang="fr">Bangladesh</country>
<wicri:regionArea>James P Grant School of Public Health, BRAC University, Dhaka</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Campbell, Harry" sort="Campbell, Harry" uniqKey="Campbell H" first="Harry" last="Campbell">Harry Campbell</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Nair, Harish" sort="Nair, Harish" uniqKey="Nair H" first="Harish" last="Nair">Harish Nair</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff24">Public Health Foundation of India, New Delhi, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Public Health Foundation of India, New Delhi</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series><title level="j">Journal of Global Health</title>
<idno type="ISSN">2047-2978</idno>
<idno type="eISSN">2047-2986</idno>
<imprint><date when="????">????</date>
</imprint>
</series>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.</p>
</sec>
<sec><title>Methods</title>
<p>We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate.</p>
</sec>
<sec><title>Results</title>
<p>We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low– and–middle income countries (LMIC) and high–income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5–8.7), US$ 51.7 (95% CI 17.4–91.0) and US$ 242.7 (95% CI 153.6–341.4)–559.4 (95% CI 268.9–886.3) in community, out–patient facilities and different levels of hospital in–patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%–115.8% of patients’ monthly household income in LMIC. The mean direct non–medical cost and indirect cost for severe pneumonia management accounted for 0.5–31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3–6.4) and 7.7 (IQR 5.5–9.9) days in LMIC and HIC respectively for these children.</p>
</sec>
<sec><title>Conclusion</title>
<p>This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Glob Health</journal-id>
<journal-id journal-id-type="iso-abbrev">J Glob Health</journal-id>
<journal-id journal-id-type="publisher-id">JGH</journal-id>
<journal-title-group><journal-title>Journal of Global Health</journal-title>
</journal-title-group>
<issn pub-type="ppub">2047-2978</issn>
<issn pub-type="epub">2047-2986</issn>
<publisher><publisher-name>Edinburgh University Global Health Society</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27231544</article-id>
<article-id pub-id-type="pmc">4871066</article-id>
<article-id pub-id-type="publisher-id">jogh-06-010408</article-id>
<article-id pub-id-type="doi">10.7189/jogh.06.010408</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Articles</subject>
</subj-group>
</article-categories>
<title-group><article-title>Cost of management of severe pneumonia in young children: systematic analysis</article-title>
<alt-title alt-title-type="running-head">Nair et al. Cost of managing severe pneumonia in young children</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Zhang</surname>
<given-names>Shanshan</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sammon</surname>
<given-names>Peter M.</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>King</surname>
<given-names>Isobel</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Andrade</surname>
<given-names>Ana Lucia</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Toscano</surname>
<given-names>Cristiana M.</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Araujo</surname>
<given-names>Sheila N</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sinha</surname>
<given-names>Anushua</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Madhi</surname>
<given-names>Shabir A.</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff8"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Khandaker</surname>
<given-names>Gulam</given-names>
</name>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
<xref ref-type="aff" rid="aff10"><sup>10</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Yin</surname>
<given-names>Jiehui Kevin</given-names>
</name>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
<xref ref-type="aff" rid="aff10"><sup>10</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Booy</surname>
<given-names>Robert</given-names>
</name>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
<xref ref-type="aff" rid="aff10"><sup>10</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Huda</surname>
<given-names>Tanvir M</given-names>
</name>
<xref ref-type="aff" rid="aff11"><sup>11</sup>
</xref>
<xref ref-type="aff" rid="aff12"><sup>12</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rahman</surname>
<given-names>Qazi S</given-names>
</name>
<xref ref-type="aff" rid="aff11"><sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>El Arifeen</surname>
<given-names>Shams</given-names>
</name>
<xref ref-type="aff" rid="aff11"><sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gentile</surname>
<given-names>Angela</given-names>
</name>
<xref ref-type="aff" rid="aff13"><sup>13</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Giglio</surname>
<given-names>Norberto</given-names>
</name>
<xref ref-type="aff" rid="aff13"><sup>13</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bhuiyan</surname>
<given-names>Mejbah U.</given-names>
</name>
<xref ref-type="aff" rid="aff14"><sup>14</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sturm–Ramirez</surname>
<given-names>Katharine</given-names>
</name>
<xref ref-type="aff" rid="aff14"><sup>14</sup>
</xref>
<xref ref-type="aff" rid="aff15"><sup>15</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gessner</surname>
<given-names>Bradford D.</given-names>
</name>
<xref ref-type="aff" rid="aff16"><sup>16</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nadjib</surname>
<given-names>Mardiati</given-names>
</name>
<xref ref-type="aff" rid="aff17"><sup>17</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Carosone–Link</surname>
<given-names>Phyllis J.</given-names>
</name>
<xref ref-type="aff" rid="aff18"><sup>18</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Simões</surname>
<given-names>Eric AF</given-names>
</name>
<xref ref-type="aff" rid="aff18"><sup>18</sup>
</xref>
<xref ref-type="aff" rid="aff19"><sup>19</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Child</surname>
<given-names>Jason A</given-names>
</name>
<xref ref-type="aff" rid="aff20"><sup>20</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ahmed</surname>
<given-names>Imran</given-names>
</name>
<xref ref-type="aff" rid="aff21"><sup>21</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bhutta</surname>
<given-names>Zulfiqar A</given-names>
</name>
<xref ref-type="aff" rid="aff21"><sup>21</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Soofi</surname>
<given-names>Sajid B</given-names>
</name>
<xref ref-type="aff" rid="aff22"><sup>22</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Khan</surname>
<given-names>Rumana J</given-names>
</name>
<xref ref-type="aff" rid="aff23"><sup>23</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Campbell</surname>
<given-names>Harry</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nair</surname>
<given-names>Harish</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff24"><sup>24</sup>
</xref>
</contrib>
<aff id="aff1"><label>1</label>
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK</aff>
<aff id="aff2"><label>2</label>
Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, PR China</aff>
<aff id="aff3"><label>3</label>
NHS Grampian, UK</aff>
<aff id="aff4"><label>4</label>
Department of Community Health, Federal University of Goias, Brazil</aff>
<aff id="aff5"><label>5</label>
State University of Maranhăo, Brazil</aff>
<aff id="aff6"><label>6</label>
New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA</aff>
<aff id="aff7"><label>7</label>
Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff>
<aff id="aff8"><label>8</label>
Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa</aff>
<aff id="aff9"><label>9</label>
National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia</aff>
<aff id="aff10"><label>10</label>
Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia</aff>
<aff id="aff11"><label>11</label>
Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh</aff>
<aff id="aff12"><label>12</label>
School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia</aff>
<aff id="aff13"><label>13</label>
Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina</aff>
<aff id="aff14"><label>14</label>
Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh</aff>
<aff id="aff15"><label>15</label>
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</aff>
<aff id="aff16"><label>16</label>
Agence de Médicine Préventive, Paris, France</aff>
<aff id="aff17"><label>17</label>
Faculty of Public Health, University of Indonesia, Jakarta, Indonesia</aff>
<aff id="aff18"><label>18</label>
Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA</aff>
<aff id="aff19"><label>19</label>
Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA</aff>
<aff id="aff20"><label>20</label>
Pharmacy Department, Children's Hospital Colorado, Aurora, CO, USA</aff>
<aff id="aff21"><label>21</label>
Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan</aff>
<aff id="aff22"><label>22</label>
Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan</aff>
<aff id="aff23"><label>23</label>
James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh</aff>
<aff id="aff24"><label>24</label>
Public Health Foundation of India, New Delhi, India</aff>
</contrib-group>
<author-notes><corresp id="cor1"><bold>Correspondence to:</bold>
Dr Harish Nair
Centre for Global Health Research
Usher Institute of Population Health Sciences and Health Informatics
University of Edinburgh Medical School
Edinburgh EH8 9AG
United Kingdom
<email xlink:href="harish.nair@ed.ac.uk">harish.nair@ed.ac.uk</email>
</corresp>
</author-notes>
<pub-date date-type="pub" publication-format="print"><month>6</month>
<year>2016</year>
</pub-date>
<pub-date date-type="pub" publication-format="electronic"><day>15</day>
<month>3</month>
<year>2016</year>
</pub-date>
<volume>6</volume>
<issue>1</issue>
<elocation-id>010408</elocation-id>
<permissions><copyright-statement>Copyright © 2016 by the Journal of Global Health. All rights reserved.</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.5/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.</p>
</sec>
<sec><title>Methods</title>
<p>We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate.</p>
</sec>
<sec><title>Results</title>
<p>We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low– and–middle income countries (LMIC) and high–income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5–8.7), US$ 51.7 (95% CI 17.4–91.0) and US$ 242.7 (95% CI 153.6–341.4)–559.4 (95% CI 268.9–886.3) in community, out–patient facilities and different levels of hospital in–patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%–115.8% of patients’ monthly household income in LMIC. The mean direct non–medical cost and indirect cost for severe pneumonia management accounted for 0.5–31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3–6.4) and 7.7 (IQR 5.5–9.9) days in LMIC and HIC respectively for these children.</p>
</sec>
<sec><title>Conclusion</title>
<p>This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.</p>
</sec>
</abstract>
<counts><page-count count="15"></page-count>
</counts>
</article-meta>
</front>
</pmc>
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