How Much Money Is Spent A Year On Finding A Cure For Heart Disease

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Cost analysis of treating cardiovascular diseases in a super-specialty infirmary

• Atul Kumar,
• Vijaydeep Siddharth,
• Soubam Iboyaima Singh,
• Rajiv Narang

ten

• Published: January 5, 2022
• https://doi.org/10.1371/journal.pone.0262190

Figures

Abstruse

Cardiovascular care is expensive; hence, economical evaluation is required to gauge resource existence consumed and to ensure their optimal utilization. There is dearth of data regarding cost analysis of treating various diseases including cardiac diseases from developing countries. The study aimed to analyze resource consumption in treating cardio-vascular affliction patients in a super-specialty infirmary. An observational and descriptive study was carried out from April 2017 to June 2018 in the Department of Cardiology, Cardio-Thoracic (CT) Center of All India Institute of Medical Sciences, New Delhi, Republic of india. As per Earth Health Organization, common cardiovascular diseases i.e. Coronary Artery Disease (CAD), Rheumatic Heart Disease (RHD), Cardiomyopathy, Congenital heart diseases, Cardiac Arrhythmias etc. were considered for cost analysis. Medical records of 100 admitted patients (Ward & Cardiac Care Unit) of cardiovascular diseases were studied till belch and number of patient records for a item CVD was identified using prevalence-based ratio of admitted CVD patient information. Traditional Costing and Fourth dimension Driven Action Based Costing (TDABC) methods were used for cost ciphering. Per bed per day price incurred by the hospital for admitted patients in Cardiac Care Unit, developed and pediatric cardiology ward was calculated to be Indian Rupee (INR) 28,144 (U.s.$ 434), INR 22,210 (U.s.$ 342) and INR 18,774 (U.s.$ 289), respectively. Inpatient price constituted almost 70% of the full toll and equipment toll accounted for more than 50% of the inpatient cost followed by homo resources toll (28%). Per patient price of treating whatsoever CVD was computed to exist INR two,47,822 (Usa $ 3842). Cost of treating Rheumatic Center Disease was the highest amongst all CVDs followed by Cardiomyopathy and other CVDs. Cost of treating cardiovascular diseases in Bharat is less than what has been reported in adult countries. Findings of this report would aid policy makers because contempo radical changes and massive policy reforms ushered in by the Government of India in healthcare commitment.

Citation: Kumar A, Siddharth V, Singh SI, Narang R (2022) Price assay of treating cardiovascular diseases in a super-specialty infirmary. PLoS 1 17(i): e0262190. https://doi.org/ten.1371/periodical.pone.0262190

Editor: Filomena Pietrantonio, San Giuseppe Hospital, ITALY

Received: June 11, 2021; Accepted: December 20, 2021; Published: Jan 5, 2022

Copyright: © 2022 Kumar et al. This is an open access article distributed nether the terms of the Creative Commons Attribution License, which permits unrestricted utilize, distribution, and reproduction in whatever medium, provided the original author and source are credited.

Information Availability: All relevant data is inside the paper.

Funding: The authors received no specific funding for this work.

Competing interests: None declared.

Introduction

Globally an estimated 17.vii one thousand thousand people died from cardiovascular diseases (CVDs) in 2015 representing 31% of all deaths and over 75% of these deaths take place in low and middle income countries [i]. India is having the highest burden of CVDs in the world and as per World Health Arrangement (WHO) estimates Non Catching Diseases (NCDs) accounts for 60% of total deaths in India out of which CVD tops the list of with 43.34%. [ii]. A study estimating the brunt of cardiovascular diseases in India revealed that from 1990 to 2016 prevalent cases of cardiovascular diseases increased from 25·vii to 54.v one thousand thousand [3].

Increasing NCDs coupled with increasing injuries have resulted in a pregnant increase in health spending in India causing loss to national income [4]. CVDs not simply impact the well-beingness of an individual simply as well holds back the economic growth of the state due to increased healthcare expenditure and macerated productivity from disability, premature death, and absence. WHO has estimated that India has spent approximately $236 billion over a catamenia of ten years between 2005–2015 on management of CVDs [5–seven]. Information technology imposes a considerable burden on regions with relatively depression per capita health budgets [viii].

Rapid scientific and technological advancement has tremendously increased the cost of managing CVDs. Individually, patients with CVDs incur more than twice the medical costs as compared to a patient without CVD of same age and sex [9]. Cardiovascular intendance is expensive; hence, economic evaluation is required to estimate resources being consumed and to ensure their optimal utilization [10]. It volition facilitate rational allocation of resource and informed determination making to formulate constructive policies [11].

The information obtained from cost analysis helps the healthcare institutions to operate more toll effectively, monitor and control costs, amend quality of care, and assist in management conclusion making, peculiarly toll containment by making costing profile of procedures more accurate [12]. There is dearth of data regarding cost analysis of treating diverse diseases including cardiac diseases from developing countries. Thus, the nowadays study is an endeavor to analyze the toll of managing admitted cardio-vascular illness patients in a super-specialty hospital.

Methodology

An observational and descriptive study was carried out from April 2017 to June 2018 in the Department of Cardiology, Cardio-Thoracic Eye (CTC) of All India Found of Medical Sciences, New Delhi, India. All India Plant of Medical Sciences is one of the leading healthcare institute in the land and CTC began functioning in 1982 with 200 hospital beds for Cardiology and Cardiothoracic & Vascular Surgery patients. Information technology has all the facilities required for comprehensive cardiac care including a catherization laboratory, cardiac anesthesia, cardiac radiology, cardiac biochemistry, cardiac pathology, nuclear medicine, stem jail cell facility, organ retrieval & banking organization, blood transfusion services etc. It has four full general wards, 8 Operating rooms, two intensive care units having 34 beds, 8 ICU beds exclusively for the neonatal & infant intensive care, five cardiac catheterisation laboratory and i coronary care unit (CCU). CTC runs various super-specialty clinics (Coronary Clinic, Prosthetic valve Dispensary, Hypertension Clinic, Arrhythmia/ Pacemaker Clinic, Heart Failure Clinic, Aortic affliction Clinic).

This study was conducted as function of post graduate residency program in the Department of Hospital Administration after obtaining necessary approval from the Institute Ideals Committee for Post Graduate Research vide IECPG-685/19.01.2017, RT31/16.02.2017. Study did non involve whatever direct or indirect interaction with patients and ethical guidelines equally prescribed by the Found Ethics Committee for the patient record review were adhered. It entailed identifying various toll centres, classifying costs and tracing all costs related to treating cardiovascular diseases through detailed and thorough perusal of various records including inpatient records to define resource consumption during hospitalisation.

CVDs such every bit Coronary Artery Illness (CAD), Rheumatic Heart Disease (RHD), Cardiomyopathy, Built heart diseases, Cardiac Arrhythmias etc. were included in the report every bit classified past WHO and equally per the expert guidance [13]. Since, the written report was carried out as part of partial fulfilment of MD programme in infirmary administration, only 100 patient care records were studied and number of patient records for a particular CVD was identified using prevalence-based ratio of admitted CVD patient data. Medical records were studied for the specific entire admission episode. Medical records of the patients who were admitted for either less than 24 hours or admitted through emergency department were excluded from the study due to operational issues of data collection and resources constraints. As per the Institute policy, approval from the Infirmary Assistants is required for studying medical records of the admitted patients for research or academic purpose.

'Procedure mapping' of diverse patient care services during the hospital stay was conducted. Information technology was washed through directly observations and in-depth discussions with the key informants i.e. faculty members, resident doctors and nurses etc. Since the availability of data was a challenge due to lack of robustness in record keeping practices, combination of methodology utilizing using Traditional Costing and Time Driven Activity Based Costing (TDABC) were used for cost computation. Replacement method of cost ciphering employing Price Aggrandizement Alphabetize (CII—As notified under the Finance Act) was adopted for arriving at the current day price from the historical costs of various capital letter assets (CII in the yr 2010–xi was 167, while for the yr 2017–xviii, it was 280, hence, CII factorial increment was calculated to exist 1.89). Annualised cost was calculated for various cost centres and after per bed per day toll was arrived Tabular array 1.

Capital letter costs

Building and its maintenance cost.

Measurement of the patient care areas (in sqm) were taken from the engineering science department for the purpose of calculation of structure price as per Key Public Works Department (CPWD) Manual 2007 (CII multiplication index ii.29). It was estimated that life of the building would be 100 years and therefore, an annual depreciation of 1% would be a reasonable estimation of the annual cost of the building. As per repair & service toll alphabetize as on 24/04/2018 issued by office of Director General, CPWD regulation, the maintenance rate for applied science works was Rs 6668.56/- per Sq.one thousand. per year for the hospital building. No cost has been attributed to the land since the land belongs to the Government of India.

Price of equipment, fixtures, and its maintenance cost.

A list of equipment used in the Cath lab, CCU and inpatient wards was populated, and its procurement cost was collected from hospital stores section. Straight-line method of depreciation (useful life 10/ & 7 years) was used to go far at an annualized equipment cost. As per the prevailing practices five percent of the total procurement price of an equipment was taken as maintenance cost and same was added to the annualized equipment price to go far at the full toll of equipment or an asset. For catheterization lab procedures, activity-based costing was utilized, while for CCU and wards, traditional method of costing was used.

Operational costs

Human resource.

Monthly gross salary was computed for diverse categories of staff. Fourth dimension spent by various categories of staff during Cath lab procedures was decided in consultation with cardinal informants (Consultants, Residents and Nursing Officers), thereafter, apportioning was washed. While, in CCU and ward, the gross monthly salary of different manpower nether various categories was computed past considering the actual number of manpower multiplied past the gross salary in that category.

Medicines, surgical and other consumables.

Treatment file of each enrolled patient was studied for ascertaining consumption of carious consumables. Consumption blueprint of various items i.due east. full general items, surgical items, stationary, linen shop etc. over a catamenia of six months was generated from hospital MIS database of the respective areas. Unit price of each item was taken from the infirmary stores and price of diverse items consumed over a period of 6 months was calculated.

Air conditioning & electricity costs.

Cost for full tonnage of refrigeration (TR), Air handling unit (AHUs), condenser and chiller pumps, cooling tower was taken from engineering services division. Operational price was taken based on its tonnage of refrigeration and electricity consumed per day including labor, spares, and fabric. Wattage and usage of various electrical appliances and fixtures was ascertained. Full number of units consumed in 24 hours by all the appliances and fixtures was calculated and total toll was arrived at.

Back up services costs.

Reference costs for support services was taken from the various studies carried out by the Section of Hospital Administration at AIIMS, New Delhi. Total per solar day load of dirty linen (in kg) of various categories generated from patient care areas under report was calculated with the assistance of Nursing Officer In charges and laundry supervisor. Cost of washing per kilogram of dirty linen was taken equally Rs 23.22. Cost of serving one meal in the general ward was estimated to be Rs. 86.77, while unit of measurement price of breakfast was taken every bit 15% of the cost of a repast. Toll of sterilizing items was estimated to be Rs. 33.9 per bed per day. The number of full medical gas outlets for each patient care area was calculated and Rs 25.56 was taken as price per manifold point [14]. Cost for managing biomedical waste management per day per bed was calculated. Additional 10% cost was added to the overall cost under the administrative caput. All costs were calculated in INR and US $ (1US $ = 64.8 INR)

Results

Cardiology department provides services to patients from various parts of the country and neighboring countries as well. Information technology has an OPD of 42000 patients, 9500 inpatient admissions per year (Average length of stay of 6.half dozen days), and more than 7000 cardiac interventions (More than thirty different types of cardiac procedures) were carried out in the year 2016–17. Virtually mutual CVD was CAD, which constituted more than 50 percent of the admitted patients. Tabular array 2 A total of 100 admitted patients were enrolled in the study for calculating toll of various kinds of cardiac illnesses Table three. Patient care menstruum has been depicted in Fig 1.

Costs were computed distinctly for the Cardiac Care Unit of measurement (CCU), adult and pediatric ward owing to variation equipment beingness used, manpower allocation, and consumption of diverse consumables. Median length of stay in instance of CCU, adult and pediatric ward was observed to be ane day (1–9 days), v days (ane–26 days) and six days (2–57 days), respectively. Cost per bed per day incurred by the infirmary for admitted patients in CCU, adult and pediatric cardiology ward was calculated to exist INR 28,144 (United states$ 434), INR 22,210 (US$ 342) and INR 18,774 (US$ 289), respectively. Overall, per patient cost of managing any cardiovascular illness in hospital was computed to exist INR 2,25,293 (Us $ 3476) and cost subsequently including administrative overheads was estimated to exist INR two,47,822 (U.s.a. $ 3824) Table 4.

Equipment cost deemed for the maximum expenditure followed past man resource cost, both together accounted for more than 70 percent of the per bed per day toll. After analyzing results of the direct costs, it was observed that more than 65% of the cost is attributable to hospitalization. Interventional/diagnostic procedures cost is more than than 18% while medication handling represented only 1.5% of the total direct costs Fig 2.

Built eye affliction is the most expensive to be treated followed past rheumatic eye disease, cardiomyopathy and so on Table five. Treatment cost of RHD is on a higher side because of the increased length of stay. In cases of cardiomyopathies, price of treatment was higher because of the costly intra cardiac devices.

Discussion

A study washed in India found that prevalence of CVDs increased in all states of India, and coronary artery diseases tops the list among CVDs followed by stroke, while rheumatic heart disease decreased by 10·8% from 1990 to 2016, and similar findings take been observed in the current written report [xv]. The toll of patient care is galloping with the advancement of engineering science and toll of consumables. Hence, it is realized that the cost of patient intendance forth with the required procedures during the hospitalization should be known to policymakers to take standardized approach and devise packages or revise existing packages, for various CVDs.

The findings of this cost analysis will be helpful in health planning and in rational allocation of finite resources especially in developing countries. With rapid transition of Indian Healthcare delivery organization from predominantly out of pocket backed based to balls based with public sector funding, these estimates may prove to be particularly useful in coming up with package cost for treating diverse CVDs under Ayushman Bharat–Pradhan Mantri January Arogya Yojana (Flagship scheme of Govt of India for providing cashless treatment to more than 500 meg beneficiaries through public and private sector hospitals) [xvi].

Toll analysis of cardiac diseases is extremely significant, considering of information technology existence the leading cause of morbidity and bloodshed. However, cost assay in a developing country is fraught with major claiming of data availability which leaves scope for much to be desired [17–19]. In this study, the comprehensive cost i.e. both direct and indirect cost (Building and equipment cost) of treating CVD patients in a infirmary setting for the year 2017–eighteen was estimated to be US $ 3476. A systematic review on the economical burden of cardiovascular illness and hypertension in low- and middle-income countries, included 80-3 studies of which fifty% were from China, Brazil, India and Mexico. Most of the studies were single center retrospective price studies conducted in secondary care settings. The costs per episode for hypertension and generic CVD were fairly homogeneous across studies; ranging between $500 and $1500. In contrast, for coronary heart illness (CHD) and stroke price estimates were generally higher and more heterogeneous, with several estimates in excess of $5000 per episode [20].

Co-ordinate to a study conducted in USA, the total hateful direct medical care costs for patients with established cardiovascular disease (CVD) was $18,953 per patient per yr with inpatient costs existence 42.8% ($8114) of total costs [21]. While, price per CVD hospitalization in 2012 in Sanghai, averaged US $ 2236.29 with the highest beingness for chronic rheumatic eye diseases (US $ 4710.78) [22]. Cost of treating CVDs in adult countries appears to be much higher compared to what has been observed in this report. A study carried out in Brazil, the cost of hospitalizations for middle failure and myocardial infarction was estimated to exist R$ three,085.xv per patients which is lower, when compared to this study [23]. Findings of our study is similar to a study which reported a full direct cost of €3198 per patient (1 Euro = 81.69), with largest part of the expenses (79%) attributable to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively [24].

In China, a retrospective report was conducted to ascertain the directly medical costs among 10000 inpatients of coronary centre diseases. It revealed that the average hospitalization expenses were $6791.38 and top three expenses were medical consumables, process charges and drugs [25]. A study conducted in Islamic republic of iran in yr 2016, the average total toll per patient was observed to be U.s.a.$1881, with hospitalization cost as the major price center [26]. A study on assessment of the direct toll of treatment of ischemic center affliction from a tertiary intendance hospital of Pakistan, revealed mean total cost of intendance to be Pakistan Rupee (PKR) 3,59,975.00. Majority of the cost expenses were contributed past the procedure price (Rs 2,73,574), followed by laboratory and diagnostic price (Rs. 37684); hospital stay cost (Rs. 27,697) and medication toll (Rs 21,019), which is similar to the present study [27]. Similar findings were observed in a report carried out in Iran where highest level of expenditure nether direct medical costs were observed on angiography, hospitalization and drug supply [28].

Findings of this report can be generalized to a like setting in a developing country particularly South East asia Region. Individuals in Low- and Middle-Income countries bear meaning fiscal burdens following CVD hospitalization, all the same with substantial variation beyond and within countries. Lack of insurance may drive much of the fiscal stress of CVD in LMIC patients and their families [29]. Health coverage and financial risk protection and inequality in access to health care remains a serious outcome for South Asian countries. Greater progress is needed to improve treatment and preventive services and financial security. Findings of this study tin provide guidance for developing packages for implementing insurance programme or reimbursement schemes through govt sponsored schemes [thirty]. Non communicable diseases (NCDs) impose a substantial fiscal burden on many households, including the poor in low-income countries. The fiscal costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving fiscal risk protection in wellness in LMIC settings and ensuring that NCDs are taken into business relationship in these systems [31].

Presented study has comprehensively considered almost all the cost centers (both straight & indirect) attributing to the expenses in management of CVDs including uppercase and mechanism costs, while most of the studies focus only on direct costs, which sets information technology apart from other studies and is the major strength of the present written report. However, due to limited availability of data sources and other resources constraint activity-based price analysis could not be carried. Most cases of suspected CVDs across the country are referred to tertiary care institutes for diagnosis and treatment, with this study being a hospital-based written report, it is possible that referral bias could have played a function. The written report sample was limited to patients admitted through the Outpatient Section of Cardiology and did not include the emergency admissions, solar day intendance cases and those patients who required surgical treatment under Cardio-Thoracic Vascular Surgery (CTVS). Similar costing studies, focusing on both direct and indirect costs involved in the management of cardiovascular diseases with larger sample size should be carried out to increment the generalizability of the findings. It is besides equally of import to measure economic burden in terms of breezy care and loss of productivity, which contributes to one-half of the economic burden of CVDs.

Determination

Cardiovascular affliction is a major public health trouble in India and is associated with high economic burden. Coronary artery disease is the nigh prevalent disease among the CVDs. Cost of treating Rheumatic Centre Disease is the highest among all CVDs followed by Cardiomyopathy and other CVDs. Price of treatment in CVDs in adult countries is reported to be higher compared to what has been observed in this study. The results of the written report would be valuable to health policy makers because recent radical changes and big-scale policy reforms ushered in by the Government of Bharat in healthcare delivery arrangement.

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