Cost analysis of hospitals performing continuous albuterol in non-intensive care settings

To compare hospital costs and resource utilization for pediatric asthma admissions based on the hospitals’ availability of continuous albuterol aerosolization administration (CAA) in non-intensive care unit (ICU) settings. We conducted a retrospective cohort study of children ages 2-17 years admitted in 2019 with a principal diagnosis of asthma using the Pediatric Health Information System. Hospitals and hospitalizations were categorized based on location of CAA administration, ICU-only versus general inpatient floors. Hospitals preforming CAA in an intermediate care unit were excluded. We calculated total cost, standardized unit costs and rates of interventions. Groups were compared using Chi-Square, t-test and Wilcoxon rank-sum test as indicated. A log linear mixed model was created to evaluate potential confounders. Twenty-one hospitals (7084 hospitalizations) allowed CAA on the floor. Twenty-four hospitals (6100 hospitalizations) allowed CAA in the ICU-only. Median total cost was $4639 (Interquartile Range (IQR) $3060–$7512) for the floor group and $5478 (IQR $3444–$8539) for the ICU-only group (p There was cost savings and decreased resource utilization for hospitals that performed CAA on the floor. Further studies exploring variations in asthma management are warranted.

本研究旨在对比不同医院在非重症监护病房（Intensive Care Unit, ICU）开展沙丁胺醇持续雾化给药（continuous albuterol aerosolization administration, CAA）的情况下，儿科哮喘住院患者的医疗成本与资源利用情况。我们采用儿科健康信息系统（Pediatric Health Information System）的数据，针对2019年收治的、主要诊断为哮喘的2~17岁儿童开展回顾性队列研究。根据CAA的给药场所，将医院及住院人次分为两类：仅可在重症监护病房开展CAA，以及可在普通住院病房开展CAA。排除在中间监护病房实施CAA的医院。我们计算了总医疗费用、标准化单位成本及各类干预措施的实施率；根据数据特征分别采用卡方检验（Chi-Square）、t检验（t-test）及Wilcoxon秩和检验（Wilcoxon rank-sum test）进行组间比较，并构建对数线性混合模型（log linear mixed model）以评估潜在混杂因素（confounders）的影响。
本研究共纳入21家可在普通住院病房开展CAA的医院，涉及7084例住院人次；另有24家仅可在重症监护病房开展CAA的医院，涉及6100例住院人次。普通病房组的中位总费用为4639美元（四分位数间距（Interquartile Range, IQR）：3060~7512美元），仅重症监护病房组的中位总费用为5478美元（IQR：3444~8539美元）（原文此处p值未完整标注）。结果显示，可在普通病房开展CAA的医院可实现成本节约，且资源利用更低。
未来需开展更多研究以探讨哮喘管理方案的差异。