Abstract
Wheezing is an important health problem in Thailand. This study aimed to estimating costs of hospitalization of preschool children with acute wheezing under societal, provider and patient’s perspectives were also studied. The study recruited 240 children, aged 6 months to 5 years, who were admitted with acute wheezing at Thammasat hospital, King Chulalongkorn Memorial hospital, Bhumiphol hospital and Saraburi hospital. Data were collected from the hospital financial database and interviewing caregivers for the expenses. Cost-to-charge ratio method was employed for valuation of direct medical costs. Informal care cost was determined by human capital approach. It is found that societal, provider and patient costs per admission were 20,269±20,537, 18,126±16,898 และ 3,020±6,632 THB, respectively. The costs during hospitalization were the maximal proportion of 94.59 percents with the direct medical costs นด 88.83 percents. The main cost component in all perspective was hoteling cost during admission. The costs in medical school hospitals were higher than other type hospitals. The prognosis of these wheezing children was studied to determine the clinical outcomes including emergency visits and hospitalization due to recurrent wheeze during the follow-up period of 24 months. Patients’ characteristics and non-invasive biomarkers including serum specific IgE to common allergens, serum 25-hydroxy-vitamin D, and urinary leukotriene E4 reflecting airway inflammation were collected at entry to determine the association with the clinical outcomes. According to the results, the participants were boys (62.7 %) and having history of recurrent wheezing at entry (59.1%). According to laboratory results, atopy was found in 75.9 percent. Vitamin D insufficiency was found in 24.8 percent. The one-year incidences of emergency visits with recurrent wheezing during the first and second years of follow-up were 67.5 percent (95% confidence interval: 60.4% to 74.2%) and 12.2 percent (95% confidence interval: 7.8% to 17.9%) respectively. The one-year incidence of hospitalization with acute wheezing during the first and second years of follow-up were 32.3 percent (95% confidence interval: 25.4% to 39.9%) and 3.9 percent (95% confidence interval: 1.6% - 7.8%) respectively. Passive smoking from household (p=0.045) and atopy (p=0.038) were significant factors associated with emergency visits of recurrent wheezing.
