# Societal cost of day-care approach (DCA): A low-cost approach in urban and rural settings for management of childhood severe pneumonia in Bangladesh

## TL;DR

A new low-cost day-care approach for treating childhood pneumonia in Bangladesh is shown to be economically viable, especially in rural areas.

## Contribution

The study introduces and evaluates a novel day-care management approach for childhood severe pneumonia in both urban and rural settings in Bangladesh.

## Key findings

- The mean societal cost per patient for the day-care approach was US$94.2 with a 4.1-day average length of stay.
- Urban facilities had significantly higher costs than rural ones, with a difference of US$17 per patient.
- Medical personnel, caregiver productivity loss, and medicines were the top cost contributors.

## Abstract

Childhood severe pneumonia is the leading cause of under-five deaths in Bangladesh. A new day-care management approach (DCA) was implemented in primary-level healthcare facilities in urban and rural areas of Bangladesh. Reliable cost estimates are important to determine the economic viability of the new management approach. The objective of this study were to estimate the mean societal cost per patient for a new Day-care approach (DCA) in managing childhood severe pneumonia, to assess cost variation in urban and rural healthcare settings, and to determine important cost predictors.

This study was conducted alongside a cluster randomized trial conducted in Bangladesh Children diagnosed with severe pneumonia were enrolled between November 2015 and March 2019. Employing a bottom-up micro-costing approach from a societal perspective, detailed household and provider cost data were collected from sixteen intervention facilities (n = 16). Data collection involved structured questionnaires administered face-to-face with facility staff, interviews with parents/caregivers, and patient record reviews. Analysis measured mean cost and cost variation across socio-economic groups, facility location, clinical variables, and determined cost-sensitive parameters. A p-value of < 0.05 was considered as statistically significant level.

1,745 children were enrolled, 63% were male, and 57% were less than a year old. The mean societal cost per patient was US$94.2 (95% CI: US$92.2, US$96.3) with a mean length-of-stay (LoS) of 4.1 days (SD ± 3.0). Costs of medical personnel (US$32.6), caregiver’s productivity loss (US$26) and medicines (US$22) were the major cost contributors. Mean cost was significantly higher for urban-located facilities compared to rural (difference US$17, 95% CI: US$12.6, US$20.8). No cost variation was found by age, sex, and clinical variables.

Findings suggest that this novel DCA management approach is a low-cost management option, and particularly beneficial for rural residences and therefore has the potential to reduce the overall cost burden for childhood severe pneumonia management. These findings have implications for policy-making decisions in resource-poor settings for childhood pneumonia management.