The economic burden of pediatric gastroenteritis to Bolivian caregivers: Predictors of catastrophic cost and overall cost burden Open Access

Abstract

Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children under five years of age, with 1.4 billion episodes and 1.7 to 3 million deaths each year, with disproportionate burden in developing countries. In Bolivia, one of the poorest countries in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with this diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related cost incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income). From 2007 to 2009, researchers interviewed caregivers 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; 551 caregivers provided complete cost data and were included in the analysis. Through multivariate logistic regression models, we determined that catastrophic cost was significantly associated (p < 0.05) with 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 at least once for this episode of diarrhea (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had been ill prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]). Through multivariate linear regression models, we determined that cost burden was also significantly associated (p < 0.05) with the same variables. These data indicate a need for further investigation into why Bolivian families seek care at private facilities, and why they may incur costs even in public facilities. Our analysis highlights the economic significance of pediatric diarrhea to Bolivian caregivers and provides insight into potential areas of intervention to reduce catastrophic cost and overall cost burden associated with pediatric diarrhea.

Table of Contents

Table of Contents

LITERATURE REVIEW ............................................................................................................... 1
ROLE ............................................................................................................................................ 14
MANUSCRIPT ............................................................................................................................ 15
TITLE ....................................................................................................................................... 15
AUTHORS ............................................................................................................................... 15
ABSTRACT ............................................................................................................................. 15
INTRODUCTION .................................................................................................................... 16
MATERIALS AND METHODS .............................................................................................. 20
Sample Population and Recruitment .................................................................................... 20
Healthcare Cost Determination ............................................................................................ 21
Data Entry and Database Management ................................................................................ 21
Variable Definitions .............................................................................................................. 22
Statistical Methods ................................................................................................................ 23
RESULTS ................................................................................................................................. 26
Characteristics of the Study Population ............................................................................... 26
Predictors of Catastrophic Cost Burden (Cost Burden Greater Than or Equal to 1%) ....... 27
Predictors of Cost Burden .................................................................................................... 29
DISCUSSION ........................................................................................................................... 31
REFERENCES ......................................................................................................................... 38
TABLES ................................................................................................................................... 43
Table 1. Characteristics of the sample .................................................................................. 43
Table 2. Mean costs ($US) for treatment, incurred by the caregiver for an episode of
pediatric diarrhea .................................................................................................................. 45

Table 3. Logistic regression model of the relationship between risk factors and catastrophic
cost (cost burden > 1%) for one pediatric diarrheal episode. ................................................ 46
Table 4. Linear regression model of the relationship between risk factors and the Log10 cost
burden for one pediatric diarrheal episode. ........................................................................... 47
FIGURES AND FIGURE LEGENDS ...................................................................................... 48
PUBLIC HEALTH IMPLICATIONS .......................................................................................... 51

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Societal costs Pediatric Gastroenteritis Health Economics Diarrhea
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Partnering Agencies	Hospital or other health care provider University, college or educational institution (other than Emory)

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