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. 2021 Nov 23;224(Supple 5):S548-S557.
doi: 10.1093/infdis/jiab329.

Hospitalization Rates and Direct Medical Costs for Fever in a Pediatric Cohort in South India

Manikandan Srinivasan  1 , Kulandaipalayam Natarajan Sindhu  1 , Atrayee Nag  1 , Arun S Karthikeyan  1 , Ranjith Kumar Ramasamy  1 , Malathi Murugesan  1 , Dilesh Kumar  1 , Santhosh Kumar Ganesan  1 , Winsley Rose  2 , Gagandeep Kang  1 , Jacob John  3
Affiliations

Hospitalization Rates and Direct Medical Costs for Fever in a Pediatric Cohort in South India

Manikandan Srinivasan et al. J Infect Dis. .

Abstract

Background: Primary data on causes and costs of hospitalization are necessary for costing and cost-effectiveness analysis. Data on incidence and causes of hospitalization and consequent expenses among Indian children are limited.

Methods: A cohort of 6000 children aged 0.5-15 years residing in urban Vellore was followed for 3 years, under the Vellore Typhoid Study, 2016-2017, and later under the Surveillance for Enteric Fever project, 2017-2019. Data on hospitalization events and associated antibiotic use, and direct medical costs for fever-related hospitalization of study children were obtained from caregivers through weekly follow-up by study field workers.

Results: The incidence of hospitalization was 33 per 1000 child-years of observation. Children aged 0.5-5 years had the highest incidence of hospitalization. The top 5 infectious causes for hospitalization were acute undifferentiated fevers, respiratory tract infections, acute gastroenteritis, enteric fever, and dengue. The overall median cost of hospitalization for fever was 4243 (interquartile range, 2502-7215) Indian rupees (INR). An episode of dengue had a median cost of 5627 INR, followed by acute undifferentiated fevers and enteric fever with median costs of 3860 and 3507 INR, respectively.

Conclusions: Hospitalization for fever is common in young children and impacts household finances in low-income Indian households.

Keywords: India; antibiotics; children; health care; hospitalization; incidence; medical costs.

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Figures

Figure 1.
Figure 1.
Causes of hospitalization in the Vellore cohort between 2016 and 2019 (n = 560). aIncludes infections of genitourinary system, viral hepatitis, mumps, meningitis, skin infections, tuberculosis, and other infectious conditions. bIncludes seizure disorders, poisoning, renal diseases, and others.
Figure 2.
Figure 2.
Year-wise distribution of top 5 infectious causes of hospitalization between 2016 and 2018 (n = 342). Year 1 = October 2016–October 2017; year 2 = November 2017–October 2018; year 3 = November 2018–October 2019.
Figure 3.
Figure 3.
Cumulative distribution of top 5 infectious causes for hospitalization, between 2016 and 2019 represented by month, showing seasonal patterns (n = 342).
See this image and copyright information in PMC

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