Arvo building, Lecture room F025, address: Arvo Ylpön katu 34.
Doctoral defence of M.Sc. (Health Care) Paula Heikkilä
The field of science of the dissertation is Paediatrics.
The opponent is professor Marjukka Mäkelä (University of Copenhagen, Denmark). Professor Matti Korppi acts as the custos.
The language of the dissertation defence is Finnish.
The hospitalisation costs and the effectiveness of the treatment in bronchiolitis
Bronchiolitis is defined as breathing difficulty caused by lower respiratory tract infections. Typically, infants under 6 months of age get bronchiolitis and in Finland, the upper age limit for bronchiolitis is 12 months. Bronchiolitis is a virus infection, with first sings similar to common flu getting worse within few days.
Bronchiolitis is a common reason for hospitalization in infancy. In the hospitals, supportive therapies are provided such as those facilitating breathing and guarantying nutrition. High flow oxygen therapy is a promising new way to treat respiratory distress. Another recently used therapy is hypertonic saline inhalations. Earlier studies have shown that other treatments, such as antibiotics, corticosteroids or medicines used for asthma, are not useful.
In this dissertation, the hospitalization costs of bronchiolitis were evaluated in Tampere University Hospital between years 2000 and 2012. The costs were based on municipal billing and were calculated separately to the emergency department, the paediatric ward and the intensive care unit. Additionally, the cost effectiveness of high flow oxygen therapy compared to low flow oxygen therapy was evaluated by a modelling analysis, as well as the costs and effectiveness of hypertonic saline inhalations compared to normal saline inhalations by a meta-analysis and modelling analysis.
The mean hospitalisation costs for the treatment episode were 8 061€ if intensive care was needed, 1 834€ for those who were treated on the ward and 359€ if the infant was treated in the emergency department only. The higher costs were associated to a longer length of stay in the hospital and especially in the intensive care unit, and to lower gestational age and lower age on admission.
High flow oxygen therapy was less expensive and more effective compared to low flow oxygen therapy. Hypertonic saline inhalations were slightly less expensive compared to normal saline inhalations but the effectiveness was also very low and event absent in some situations.
The use of intensive care increases the hospitalisation costs. High flow oxygen therapy seems to decrease the use of intensive care and so it decreases the hospitalisation costs. Moreover, it seems to be safe to be used. However, only few studies on high flow oxygen therapy has been published and so, more studies are needed. Instead, hypertonic saline inhalations are not effective enough that any real cost-savings could be gained, and such inhalations should not be routinely used anymore. Additionally, it is possible that hypertonic saline inhalations do not improve the infant`s condition at all.
The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2320, Tampere University Press, Tampere 2017. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1824, Tampere University Press 2017.