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Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective
  1. Marufa Sultana1,
  2. Jennifer J Watts1,
  3. Nur H Alam2,
  4. A S G Faruque2,
  5. George J Fuchs3,
  6. Niklaus Gyr4,
  7. Nausad Ali2,
  8. Md Jobayer Chisti2,
  9. Tahmeed Ahmed2,
  10. Julie Abimanyi-Ochom1,
  11. Lisa Gold1
  1. 1Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
  2. 2Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
  3. 3Department of Paediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA
  4. 4Department of Internal Medicine, University of Basel, Basel, Switzerland
  1. Correspondence to Dr Marufa Sultana, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong 3125, Victoria, Australia; m.sultana{at}


Objective To estimate inpatient care costs of childhood severe pneumonia and its urban–rural cost variation, and to predict cost drivers.

Design The study was nested within a cluster randomised trial of childhood severe pneumonia management. Cost per episode of severe pneumonia was estimated from a healthcare provider perspective for children who received care from public inpatient facilities. A bottom-up micro-costing approach was applied and data collected using structured questionnaire and review of the patient record. Multivariate regression analysis determined cost predictors and sensitivity analysis explored robustness of cost parameters.

Setting Eight public inpatient care facilities from two districts of Bangladesh covering urban and rural areas.

Patients Children aged 2–59 months with WHO-classified severe pneumonia.

Results Data on 1252 enrolled children were analysed; 795 (64%) were male, 787 (63%) were infants and 59% from urban areas. Average length of stay (LoS) was 4.8 days (SD ±2.5) and mean cost per patient was US$48 (95% CI: US$46, US$49). Mean cost per patient was significantly greater for urban tertiary-level facilities compared with rural primary–secondary facilities (mean difference US$43; 95% CI: US$40, US$45). No cost variation was found relative to age, sex, malnutrition or hypoxaemia. Type of facility was the most important cost predictor. LoS and personnel costs were the most sensitive cost parameters.

Conclusion Healthcare provider cost of childhood severe pneumonia was substantial for urban located public health facilities that provided tertiary-level care. Thus, treatment availability at a lower-level facility at a rural location may help to reduce overall treatment costs.

  • Child Health
  • Child Health Services
  • Health Care Economics and Organizations
  • Health services research

Data availability statement

Data are available upon reasonable request.

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  • Contributors MS, JJW and LG conceptualised the study. MS, NHA, MJC, ASGF, GJF and NG designed the study and data collection instruments, and supervised data collection. MS and NA supervised data collection and analysed data under supervision of JA-O, JJW and LG. MS drafted the initial manuscript and LG supervised each stage of drafting the initial manuscript. JJW, NHA, NA, ASGF, NA, GJF, NG, MJC, TA and LG critically reviewed and revised the manuscript. All authors approved the final manuscript. MS is guarantor.

  • Funding This work was jointly supported by UNICEF, Botnar Foundation, UBS Optimus Foundation and EAGLE Foundation, Switzerland (grant numbers: GR-01083; GR-01269). MS was supported by Deakin University Postgraduate Research (DUPR) scholarship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.