Factors associated with high-cost hospitalization for peritonitis in children receiving chronic peritoneal dialysis in the United States
Although peritonitis causes significant morbidity and mortality in children receiving chronic peritoneal dialysis (CPD), little is known about costs associated with treatment.
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.
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.
Hospitalization-related costs for peritonitis treatment are substantial and arise from a variety of service lines. Fungal peritonitis is associated with high-cost hospitalization.
KeywordsPeritoneal dialysis-related infection Cost-to-charge ratio Wage-adjusted charges Service line Pediatric peritonitis Direct cost
Compliance with ethical standards
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.
- 2.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, BethesdaGoogle Scholar
- 3.2011 NAPRTCS Annual Report. North American Pediatric Renal Trials and Collaborative Studies website https://web.emmes.com/study/ped/announce.htm. Accessed February 5, 2018
- 6.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):1477–1484CrossRefGoogle Scholar
- 8.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–S86CrossRefGoogle Scholar
- 9.Shwartz M, Young DW, Siegrist R (2015–2016) The ratio of costs to charges: how good a basis for estimating costs? Inquiry 32(4):476–481Google Scholar