Cost-benefit analysis of implementing a pediatric early warning system at a pediatric oncology hospital in a low-middle income country

Background Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in low-income and middle-income countries (LMICs). Pediatric early warning systems (PEWS) assist with the early identification of deterioration. To the authors' knowledge, no studies to date have evaluated the cost-benefit of PEWS in LMICs. Methods A PEWS was implemented at the National Pediatric Oncology Unit (Unidad Nacional de Oncologia Pediatrica [UNOP]), a pediatric oncology hospital in Guatemala, resulting in a reduction in unplanned pediatric intensive care unit (PICU) transfers. Variable costs of maintaining the PICU and hospital floor were calculated for the year prior to and after the implementation of PEWS using administrative data. PEWS implementation costs were tabulated. The number of PICU inpatient days averted due to reduced unplanned PICU transfers after implementation was calculated, adjusting for changes in hospital inpatient days. Savings per inpatient day from unplanned PICU transfers were calculated. All costs were adjusted for inflation. Results There were 457 fewer PICU inpatient days due to unplanned transfers noted the year after implementation of PEWS, adjusting for changes in hospital volume. The variable costs of an unplanned PICU transfer versus a bed on the hospital floor was $806 per day. The total cost of implementing PEWS at UNOP was $13,644 ($7 per admission). Through reductions in variable PICU costs, UNOP saved a net $173 per admission ($354,514 annual net savings) after implementation of PEWS. The cost savings were sustained in a series of more conservative 1-way sensitivity analyses. Conclusions Implementation of PEWS at UNOP resulted in an incremental savings due to a reduction in the number of unplanned PICU transfers. The results of the current study demonstrate that hospital investment in PEWS can improve the quality of pediatric cancer care, optimize PICU use, and reduce costs.