Abstract
Background
Although peritonitis causes significant morbidity and mortality in children receiving chronic peritoneal dialysis (CPD), little is known about costs associated with treatment.
Methods
We analyzed 246 peritonitis-related hospitalizations in the USA, linked by the Standardized Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) and Pediatric Health Information Systems (PHIS) databases. Multivariable logistic regression was used to assess the relationship between high-cost hospitalizations (at or above the 75th percentile) and patient characteristics. Multivariable modeling was used to assess differences in the service-line specific geometric mean between (1) high- and low-cost (below the 75th percentile) hospitalizations and (2) fungal versus other types of peritonitis. Wage-adjusted hospitalization charges were converted to estimated costs using reported cost-to-charge ratios to estimate the cost of hospitalization.
Results
High-cost hospitalizations were associated with the following: age 3–12 years, Hispanic ethnicity, intensive care unit (ICU) stay, length of stay (LOS), and fungal peritonitis. Whereas absolute standardized cost by service line was significantly different when comparing high- and low-cost hospitalizations, the percentage of total cost by service line was similar in the two groups. Cost per case for fungal peritonitis was higher (p < 0.001) in every service line except pharmacy when compared to other peritonitis cases. The median (IQR) cost of hospitalization for the treatment of peritonitis was $13,655 ($7871, $28434) USD.
Conclusions
Hospitalization-related costs for peritonitis treatment are substantial and arise from a variety of service lines. Fungal peritonitis is associated with high-cost hospitalization.
Similar content being viewed by others
References
Fadrowski JJ, Alexander SR, Warady BA (2012) The demographics of dialysis in children pediatric dialysis. In: Warady BA, Schaefer F, Alexander SR (eds) Pediatric Dialysis, 2nd edn. Springer, New York, pp 37–52
United States Renal Data System (2017) 2017 USRDS annual data report: volume 2: end-stage renal disease in the United. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda
2011 NAPRTCS Annual Report. North American Pediatric Renal Trials and Collaborative Studies website https://web.emmes.com/study/ped/announce.htm. Accessed February 5, 2018
Schaefer F, Feneberg R, Aksu N, Donmez O, Sadikoglu B, Alexander SR, Mir S, Ha IS, Fischbach M, Simkova E, Watson AR, Moller K, von Baum H, Warady BA (2007) Worldwide variation of dialysis-associated peritonitis in children. Kidney Int 72(11):1374–1379
Coyte PC, Young LG, Tipper BL, Mitchell VM, Stoffman PR, Willumsen J, Geary DF (1996) An economic evaluation of hospital-based hemodialysis and home-based peritoneal dialysis for pediatric patients. Am J Kidney Dis 27(4):557–565
Neu AM, Miller MR, Stuart J, Lawlor J, Richardson T, Martz K, Rosenberg C, Newland J, McAfee N, Begin B, Warady BA, SCOPE Collaborative participants (2014) Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative. Pediatr Nephrol 29(9):1477–1484
Neu AM, Richardson R, Lawlor J, Stuart J, Newland J, McAfee N, Warady BA, SCOPE Collaborative Participants (2016) Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney 89(6):1346–1354
Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yak HK, Schaefer F (2012) Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 32(Suppl 2):S32–S86
Shwartz M, Young DW, Siegrist R (2015–2016) The ratio of costs to charges: how good a basis for estimating costs? Inquiry 32(4):476–481
Piraino B, Bernardini J, Jonston JR (1990) Cost analysis of peritoneal catheter infections. Perit Dial Int 10(3):241–242
Makhija DU, Walton SM, Mora JP, Sanabria RM (2017) Economic impact of a peritoneal dialysis continuous quality improvement program in Colombia. Perit Dial Int 37(2):165–169
Hsia DC, Krushat WM, Fagan AB, Tebbutt JA, Kusserrow RP (1988) Accuracy of diagnostic coding for Medicare patients under the prospective payment system. N Engl J Med 318(6):352–355 Erratum in N Eng J Med (1990) 322(21)
Heywood NA, Gill MD, Charlwood N, Brindle R, Kirwan CC, Northwest Research Collaborative (2016) Improving accuracy of clinical coding in surgery: collaboration is key. J Surg Res 204(2):490–495
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
The Institutional Review Board (IRB) at each participating center approved the collaborative protocol and informed consent was obtained where required by the institution’s IRB.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
SCOPE Investigators: complete list of participating centers available in Table 3 in the Appendix
Appendix
Appendix
Rights and permissions
About this article
Cite this article
Redpath Mahon, A.C., Richardson, T., Neu, A.M. et al. Factors associated with high-cost hospitalization for peritonitis in children receiving chronic peritoneal dialysis in the United States. Pediatr Nephrol 34, 1049–1055 (2019). https://doi.org/10.1007/s00467-018-4183-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-018-4183-0