The economic burden of pediatric gastroenteritis to Bolivian families: a cross-sectional study of correlates of catastrophic cost and overall cost burden

• Type of Material: Article
• Authors: Rachel M Burke, Emory University; Emily R Smith, Emory University; Rebecca Moritz Dahl, Emory University; Paulina A Rebolledo, Emory University; Maria del Carmen Calderón, Hospital Mario Ortiz Suárez; Beatriz Cañipa, Hospital Materno-Infantil; Edgar Chavez, Hospital Boliviano Holandés; Rolando Pinto, Hospital del Niño Manuel Ascencio Villarroel; Luis Tamayo, Hospital del Niño; Carlos Terán, Hospital Albina R. Patiño; Ángel Veizaga, Hospital Boliviano Holandés; Remy Zumaran, Hospital Materno-Infantil; Volga Iñiguez, Universidad Mayor de San Andrés; Juan Leon, Emory University
• Language: English
• Date: 2014
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Burke et al.; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.biomedcentral.com/1471-2458/14/642
• Title of Journal or Parent Work: BMC Public Health
• ISSN: 1471-2458
• Volume: 14
• Issue: 642
• Grant/Funding Information: PAR was supported by the National Institute of Allergy and Infectious Diseases (Award number T32AI074492).; This work was supported in part by The Eugene J. Gangarosa Fund; the Anne E. and William A. Foege Global Health Fund; the O.C. Hubert Charitable Trust; the RSPH Student Initiative Fund; the NIH Global Frameworks Grant (2007–2010); the Emory University Global Health Institute; the Laney Graduate School at Emory University; the New Aid Fellowship; the Bolivia National Rotavirus Surveillance Program (BNRSP); the Swedish Cooperation ASDI-UMSA (Diarrhea Disease Project); PHS Grant UL1 TR000454 from the Clinical and Translational Science Award Program, National Institutes of Health, National Center for Research Resource; the Emory + Children’s Pediatric Center Seed Grant Program; The National Institutes of Health/NIAID grant U19-AI057266; and the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.; RMB was supported in part by an NIH T32 training grant in reproductive, pediatric, and perinatal epidemiology (HD052460-01).; JSL was supported in part by funds from the Emory University Global Health Institute, NIH-NIAID (1K01AI087724-01) and USDA-NIFA (2010-85212-20608) grants.
• Keywords: Societal costs; Pediatric gastroenteritis; Diarrhea; Health economics
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

Background Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income). Methods From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model). Results We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child’s first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]). Conclusions Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.