İstanbul'da üçüncü basamak yenidoğan yoğun bakım ünitesi maliyet analizi

Amaç: Perinatal ve neonatal bakım alanındaki gelişmeler, daha fazla sayıda prematüre veya riskli bebeğin yaşamasına olanak sağlamıştır. Özellikle prematüre bebekler, hastanede uzun yatış süreleri nedeniyle Yenidoğan Yoğun Bakım Ünitesi (YYBÜ)’nün doluluk oranlarını arttırmaktadır. Yenidoğan yoğun bakım hastaları, maliyet açısından hastaneye yatışların en yüksek grubunu oluşturmaktadır. Bu çalışmada, YYBÜ’ye yatan hastaların maliyetini hesaplamak ve maliyeti etkileyen faktörleri belirleyerek maliyetin azaltılması noktasında yeni hedefler belirlemeyi amaçladık.Materyal ve Metod: Bu çalışmada 1 Ocak 2009 ile 31 Aralık 2009 tarihleri arasında YYBÜ’ye yatırılıp takip ve tedavi edilen 738 hastanın demografik özellikleri, YYBÜ’ye yatış tanıları ve bu hastalara yapılan giderler retrospektif olarak incelendi. Elde edilen verilerin maliyet analizi yapıldı.Bulgular: Çalışmaya 738 hasta hasta alındı. Bu hastaların 398 (%53,9)’i erkek, 340 (%46,1)’ı kızdı. Maliyet açısından bakıldığında, 750-999 gram doğum ağırlığı olan bir bebek için ortalama günlük bakım maliyeti 799,16 TL, 1000-1249 g 650,76 TL, 1250-1499 g 448,30 TL, 1500-2499 g 361,64 TL, 2500-4000 g 312,55 TL, > 4000 g doğan hastalarda 308,12 TL bulundu. Gebelik Haftası (GH)’ye göre maliyet değerlendirildiğinde; GH ≤ 27 her bir bebek için ortalama günlük bakım maliyeti 805,89 TL, 28-31 GH için 534,17 TL, 32-34 GH için 400,23 TL, 35-37 GH için 385,97 TL, 38-42 GH için 302,28 TL saptandı. GH ve doğum ağırlığı arttıkça, hastanede yatış süresi ve toplam günlük ortalama maliyetlerinin azaldığı görüldü (p<0,05). Respiratuvar distres sendromu (RDS), siyanotik konjenital kalp hastalıkları (KKH), asiyanotik KKH, erken neonatal sepsis, konjenital pnömoni, yenidoğanın geçici takipnesi (YDGT), mekonyum aspirasyon sendromu (MAS), perinatal asfiksi, fetal distres tanıları alan hastaların toplam günlük ortalama maliyetlerinin yüksek olduğu görüldü (p<0,05). Çalışmamızda <1500 g altında sağ kalım oranı %81,4 ve <1000 g bebeklerin sağ kalım oranı % 36,3 saptandı. GH’sine göre özellikle ≤ 27 GH bebeklerin sağ kalım oranı % 39,5 olarak saptandı.Sonuç: Hastanede kalış süresi ve maliyetin en güçlü belirleyici faktörlerini GH, doğum ağırlığı, RDS, fetal distres, perinatal asfiksi, asiyanotik KKH, siyanotik KKH, YDGT, erken neonatal sepsis, konjenital pnömoni ve MAS olarak saptadık. Özellikle YYBÜ’de yatırılan hastaların gebelik haftası ve doğum ağırlıkları azaldıkça, hastane yatış süresinin uzadığı ve maliyetin arttığı, hastaların sağkalım oranlarının azaldığı görüldü. Bunun sonucunda YYBÜ’nün maliyetini azaltmanın en efektif yolunun erken doğumun önlenmesi olduğu belirlendi.

Anahtar Kelimeler:

Yenidoğan yoğun bakım, maliyet analizi, yenidoğan, Prematürite

The cost analysis of a third level neonatal intensive care unit in Istanbul

Background: Developments in the field of perinatal and neonatal care have allowed a greater number of premature or risky infants to survive. Especially premature babies, because of the long length of stay in hospital Neonatal Intensive Care Unit (NICU) 's are increasing their occupancy rates. Neonatal intensive care diseases, in terms of costs constitute the largest group of hospitalization. In this study, we aimed to determine the cost of the patients in NICU, to determine the factors that affect the cost and to set new targets for what can be done to reduce the cost.Material and Methods: The data of 738 patients who were admitted to the NICU between January 1st, 2009 and December 31st, 2009 and were followed up and treated were evaluated retrospectively. The cost analysis of all obtained data was performed.Results: 398 (53.9%) of the 738 patients were male and 340 (46.1%) were female. In terms of cost, the average daily cost of care for a baby with a birth weight between 750-999 grams was 799.16 TL, 650.76 TL for babies 1000-1250 g, 448.30 TL for babies 1250-1499 g, 361.64 TL for babies 1500-2499 g, 312.55 TL for babies 2500-4000 g and 308.12 TL for those >4000 g. When the cost according to gestational week is evaluated; a baby with less than 28 weeks were found to be 805.89 TL, 28 to 31 weeks 534.17 TL, 32 to 36 weeks 400.23 TL, 35 to 37 weeks 385.97 TL and 38 weeks’ or longer 302.28 TL. As birth weight and gestational week increased, hospitalization time and total daily average costs decreased (p <0.05). Total daily average cost of patients with respiratory distress syndrome (RDS), cyanotic congenital heart diseases (CCHDs), acyanotic congenital heart diseases (CHDs), early neonatal sepsis, congenital pneumonia, transient tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), perinatal asphyxia and fetal distress was found to be high (p <0.05). In our study, the survival rate of infants under <1500 g was 81.4% and <1000 g was 36.3%. According to gestational week, the survival rate of less than 28 weeks infants was 39.5%.Conclusion: We found that gestational week, birth weight, RDS, fetal distress, asphyxia, CCHDs, acyanotic CHDs, TTN, early neonatal sepsis, congenital pneumonia and MAS were the strongest determinants of hospital stay and cost. It was observed that the duration of hospital stay and cost increased and the survival rates of the patients decreased especially as the gestational week and birth weights of the patients hospitalized in the NICU decreased. As a result, the most effective way to reduce the cost of the NICU was to prevent premature birth.

Keywords:

Neonatal intensive care, cost analysis, newborn, Prematurity,

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