Costs of poison-related hospitalizations at an urban teaching hospital for children
A. Woolf, J. Wieler and D. Greenes
Division of General Pediatrics, Children's Hospital, Boston, MA, USA.
BACKGROUND: Childhood poisonings continue to exact a notable toll in
injury-related morbidity and economic cost. Because a substantial portion
of this morbidity and economic cost is associated with hospitalization, an
analysis of the cost of poisoning hospitalizations might help to identify
areas in which medical care could be improved and costs could be reduced.
OBJECTIVE: To assess the aggregate cost of poison-related hospitalizations
and to analyze the trends in categorical poisoning costs during a 4-year
period. DESIGN: Cost-benefit analysis of charge data and length of stay
(LOS) for poison-related hospitalizations. SETTING: Admissions to one urban
children's hospital. PATIENTS: Case mix data were reviewed to identify
those children whose hospitalizations had a primary discharge diagnosis
related to poisoning in fiscal years 1992 to 1995. MAIN OUTCOME MEASURES:
Mean aggregate hospital charges and LOS for poisonings were compared for
each of the 4 years of the study. Comparisons were also made with charges
and LOS for hospitalizations for all other diagnoses during the same
period. Trends in hospital charges and LOS for the most common specific
types of poisoning were analyzed individually. Linear regression statistics
were used to compare the costs and LOS of specific types of poisoning.
RESULTS: There were 638 poison-related hospitalizations during the 4-year
study (0.9% of all pediatric hospital admissions). Charges per case
decreased from $7934 in fiscal year 1992 to $4968 in fiscal year 1995 (z =
-2.74, P = .006); mean LOS decreased from 5.85 days in 1992 to 3.45 days in
1995 (z = 2.84, P = .005). These trends exceeded smaller trends toward
decreasing charges and LOS seen also for non-poison-related
hospitalizations. Acetaminophen, lead, and antidepressant medications were
the most common and most costly specific agents implicated in
poison-related hospitalizations during the study period. Linear regression
analysis showed a significant decrease in charges (F = 6.35, R2 = 0.09, P =
.014) and LOS for acetaminophen (F = 4.30, R2 = 0.063, P < .04) but not
for lead or antidepressant poison-related hospitalizations. CONCLUSIONS:
Despite an increasing number of children hospitalized for poisoning at one
institution during a 4-year period, per case hospital charges decreased
substantially. The cost savings were associated with a marked decrease in
LOS. Still, poison-related admissions to a single pediatric facility
accounted for almost $1 million in hospital charges in fiscal year 1995. A
few agents are overrepresented; new poisoning prevention measures aimed at
these toxic agents are warranted. We conclude that further outcomes studies
are needed to delineate cost-effective improvements in patient care
targeted toward poisonings owing to those agents.
