Abstract
Background
The increasing incidence of pediatric inflammatory bowel disease (IBD), along with more extensive and severe disease in children, raises concern for related health care ...expenditures.
Aim
The aim of this study was to quantify and characterize costs of pediatric IBD in the year following diagnosis.
Methods
We identified all patients diagnosed with IBD at Connecticut Children’s Medical Center in 2016 with a minimum of 1 year follow-up. Clinical and demographic factors were recorded at diagnosis. We examined paid service and professional costs related to outpatient medications and infusions, outpatient procedures and radiology imaging, inpatient services, and outpatient visits. Actual dollar reimbursements were from private and public payers. Data is reported as mean ± SD and median (IQR).
Results
First-year cost data were collected on 67 patients (43 Crohn’s disease CD, 24 ulcerative colitis UC, mean age 13 years SD 3.22) revealing a mean cost of $45,753 (SD $37,938), with $43,095 (SD $30,828) for CD and $50,516 (SD $48,557) for UC. Severe CD (n = 11) had a mean cost of $71,176 (SD $43,817) and severe UC (n = 5) $134,178 (SD $40,920). Patients receiving infusion therapy had a mean cost of $59,376 (SD $38,724) compared with $27,903 (SD $28,795) for those not receiving infusions. Overall cost distribution showed 37% from infusion costs, 25% hospital costs, 18% outpatient procedures, 10% outpatient oral medications, 7% outpatient imaging, and 3% outpatient visits.
Conclusions
Infusion therapy is a key driver of first-year costs for children newly diagnosed with IBD. Understanding cost distribution in relation to disease presentation can be helpful to anticipate future related costs.
Pediatric inflammatory bowel disease is increasing in incidence and severity, which raises concern for related health care expenditures. Severity of disease at time of diagnosis and use of biologic infusion therapy dramatically increase costs in the first year after diagnosis.
OBJECTIVE To evaluate the utility of procalcitonin (PCT) in identifying cobacterial pneumonia in pediatric patients with known viral respiratory infection.
METHODS A retrospective cohort study was ...conducted in a stand-alone children's hospital during 2 time periods (period 1: October 1, 2014, to March 31, 2015; period 2: October 1, 2015, to March 31, 2016). Patients admitted with any upper respiratory tract infection were included. Exclusion criteria included any condition compromising lung function, age <30 days or >18 years, or lack of PCT (period 2). PCT values of <0.5 ng/mL were considered normal, whereas values of >1.5 ng/mL were used to identify cobacterial pneumonia. Receiver-operator characteristic curves were used with multiple logistic regression to evaluate patient variables.
RESULTS Of the 374 pediatric patients evaluated, 64% were classified as having viral pneumonia and 23% as having cobacterial pneumonia across both study time periods. Non-significant predictors of cobacterial pneumonia included temperature (p = 0.0795, p = 0.1466), WBC count (p = 0.8774, p = 0.6675), and C-reactive protein (p = 0.7115, p = 0.3835). Median initial PCT for patients with viral pneumonia was 0.14 ng/mL compared with 1.41 ng/mL in patients with cobacterial pneumonia; median second PCTs were 0.26 ng/mL (viral pneumonia) and 4.55 ng/mL (cobacterial pneumonia). Patients with an elevated PCT had 17.5 times (95% CI, 5.2, 59.1) greater odds of having a cobacterial pneumonia.
CONCLUSIONS PCT was found to be strongly associated with cobacterial pneumonia with an underlying viral etiology. Temperature, WBC, and C-reactive protein failed to be significant predictors in differentiating between viral and cobacterial pneumonia.
Limited data are available for long-term outcomes of pediatric patients with abdominal abscess or phlegmon at diagnosis of Crohn disease.
We performed a retrospective chart review of such children ...over a recent 6-year period at 5 pediatric inflammatory bowel diseases.
Fifty-two patients (mean age 15.9 ± 1.8 years) were reviewed. Thirty-six had an abscess and 27 (75%) required resectional therapy compared to 16 with phlegmon which 10 (63%) requiring surgery. Overall (37/52) 71% had surgery which was performed within 6 months in 32 (86%).
A similar high surgical rate exists whether pediatric patients with Crohn disease present with abscess or phlegmon.
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