Costs of admission for paediatric pneumonia in a setting of human immunodeficiency virus infection

BACKGROUND: Pneumonia in South African children remains a major public health concern. The costs of hospital admission for pneumonia should be determined, especially where human immunodeficiency virus (HIV) infection is common. OBJECTIVE: To determine the hospital costs of children (HIV-infected vs. non-HIV-infected) admitted for the management of pneumonia and compare them in the public and fee-for-service sectors. METHODS: A retrospective review of paediatric admissions in 2007 was performed. Costs were determined for the public and fee-for-service sectors. Outcome measures included hospital mortality and comparative costs of admission. RESULTS: There were 132 admissions in a public sector facility (67% HIV-infected), and 7882 in the fee-for-service sector (1.2% HIV-infected). Total mortality was respectively 25% in the public and 0.04% in the fee-for-service sectors. The mean cost for HIV-infected patients was respectively US$639.06 and US$10540.04 in the public and fee-for-service sectors. For non-HIV-infected patients, the cost was respectively US$399.45 and US$3936.87. Length of stay for HIV-infected patients was longer by respectively 1.8 days and 5.7 days in the public sector among admissions to the ward and to the paediatric intensive care unit. CONCLUSION: Admission for HIV-infected children with pneumonia costs significantly more in both sectors. Preventive strategies are needed.