Ezgi Balkarlı1, Elif Kıymet2, Elif Böncüoğlu3, Şahika Şahinkaya4, Miray Yılmaz Çelebi4, Hurşit Apa5, Timur Meşe6, Hasan Ağın7, Süleyman Nuri Bayram4, İlker Devrim4

1Department of Child Health and Diseases, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Türkiye
2Department of Pediatric Infectious Diseases, Batman Training and Research Hospital, Batman, Türkiye
3Department of Pediatric Infectious Diseases, Konya City Hospital, Konya, Türkiye
4Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
5Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
6Department of Pediatric Cardiology, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
7Pediatric Intensive Care, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Türkiye

Keywords: COVID-19, cost analysis, intravenous immunoglobulin.


Objectives: This study aimed to evaluate the diagnostic tests and treatments applied in patients with multisystem inflammatory syndrome in children (MIS-C) and to determine the effect of the disease on health costs.

Patients and methods: This retrospective cohort study included 59 MIS-C patients (40 males, 19 females; mean age: 7.7±4.2 years; range, 4 months to 16.5 years) who were admitted and treated between April 1, 2020, and November 1, 2021. Demographic and clinical features with hospital costs and length of stay were retrospectively reviewed from the medical files and computerized system of the hospital. Direct medical care costs of items were calculated with the hospital perspective using a combination of microcosting technique (resource-based accounting method) and hospital list data. Cases were classified as mild, moderate, or severe, and the patients were divided into two groups: the mild group and the moderate-severe group. Classification was determined by the vasoactive inotropic score (VIS), degree of respiratory support, and evidence of organ damage.

Results: The mean age of the cases in the mild group was 6.5±3.7 years, and the mean age of the cases in the moderate-severe group was 9.2±4.3 years. Of 59 patients, 19 (32.2%) were followed up in the pediatric intensive care unit. The median duration of hospitalization in the hospital was 8 (interquartile range: 7-12) days. The total cost of the patients hospitalized with the diagnosis of MIS-C during the study period was 849,242.93$, and the mean cost per patient was 14,393.94±9,631.92$. In the distribution of the total cost of hospitalization according to expenses, the highest rate was pharmacy and blood products (51.99%) and IVIG costs (43.99%). While the mean total cost per person was 13,682.87±8,799.63$ in mild cases, it was 16,433.82±9,440.02$ in moderate-severe cases, and no statistically significant relationship was found between the two groups (p>0.05). There was no difference in the mean cost per patient between the cases with and without heart, lung, kidney, or neurologic involvement and advanced respiratory support (p>0.05). There was a strong positive correlation between the total costs and age (r=0.883, n=59, p<0.0001), with increased amount of costs with increased age.

Conclusion: In the study, no statistically significant correlation was found between the total cost of per person in the mild group and the moderate-severe group (p>0.05). This finding may be due to the wide use of IVIG in MIS-C treatment, in addition to low transfer rates to pediatric intensive care units due to high-flow nasal cannula usage.

Citation: Balkarlı E, Kıymet E, Böncüoğlu E, Şahinkaya Ş, Yılmaz Çelebi M, Apa H, et al. The evaluation of the burden of multisystem inflammatory syndrome in children on health economics. Arch Rheumatol 2024;39(1):10-19. doi: 10.46497/ArchRheumatol.2023.10147.

Ethics Committee Approval

The study protocol was approved by the University of Health Sciences Dr. Behçet Uz Pediatric Diseases and Surgery Hospital Clinical Research Ethics Committee (date: 08.10.2020, no: 2020/14-06). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept: ‹.D.; Design: E.B., E.B.; Control/supervision: ‹.D., S.N.B., E.B.; Data collection and/or processing: E.K., .., M.Y.Ç.; Analysis and/or interpretation: ‹.D., E.B.; Literature review, writing the article: E.B.; Critical review: ‹.D., S.N.B., H.A., H.A., T.M.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.