31 - Cost of pediatric pneumonia episodes with or without chest radiography

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 31
Publication Number: 31.111

Alexandra T. Geanacopoulos, Boston Children's Hospital, Jamaica Plain, MA, United States; Mark I. Neuman, Boston Children's Hospital, Boston, MA, United States; Kenneth Michelson, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Alexandra (Ally) T. Geanacopoulos, MD (she/her/hers)

Fellow in Pediatric Emergency Medicine
Boston Children's Hospital
Boston Children's Hospital
Jamaica Plain, Massachusetts, United States

Background: Significant variation exists in the diagnostic work-up of community-acquired pneumonia (CAP) in the pediatric emergency department (ED). It is unclear whether routine performance of chest radiograph (CXR) is a cost-effective strategy for diagnosis. A cost analysis of CAP diagnosis with and without CXR could inform strategies for cost-effective care.

Objective: To assess the costs of CAP episodes with and without CXR among children discharged from the ED.

Design/Methods: This was a retrospective cohort study of children 3 months to 18 years discharged with a diagnosis of CAP from any ED in 8 states within the Healthcare Cost and Utilization Project State ED and Inpatient Databases between July 1, 2014 and September 30, 2019. The primary exposure was CXR performance at the index ED visit. We evaluated total costs within the 28-day period following ED discharge for pneumonia, inclusive of the index visit and all subsequent ED and hospital care. Costs were calculated using ED-level charges and ED-year-specific cost-to-charge ratios and were Winsorized at the 0.5th and 99.5th percentiles. Mixed-effects linear regression models adjusted for patient-level variables and markers for illness severity were performed to evaluate the association between CXR and costs.

Results:

We evaluated 225,781 children with CAP (Figure 1). Most (55.7%) children were 1-5 years of age and the majority (86.2%) of children had CXR at the index ED visit (Table 1). Median costs of the total 28-day episodes, index ED visits, and subsequent visits were $314 (IQR $208-497), $287.70 (IQR:$195-$433), and $255 (IQR:$133-$637), respectively. CXR at the index ED visit was associated with a $32.72 (95% CI $21.88-43.56) 28-day savings per patient who received a CXR after adjusting for patient-level variables and illness severity (Table 2). Costs during the subsequent visits (adjusted ß -26.34, 95%CI -36.35, -16.33) accounted for the majority of the observed difference as compared to the index ED visit (adjusted ß -6.38, 95%CI -10.03, -2.73). The predicted cost savings of CXR performance in all patients in the cohort was $1,023,122 (95%CI $684,166-$1,362,078).

Conclusion(s): Performance of CXR at time of CAP diagnosis may be a cost-effective strategy when considering the downstream provision of care among patients who require subsequent healthcare after initial discharge from the ED.