The mean cost of the initial 24-hour emergency room management of acute heart failure was USD 140.03, primarily driven by diagnostics at 88.35% of costs.
What is the cost of the initial 24-hour emergency room management of acute heart failure guided by a clinical pathway in a tertiary government hospital in the Philippines?
The initial 24-hour emergency room management of acute heart failure in the Philippines costs an average of USD 140.03, driven primarily by diagnostics, representing a significant financial burden relative to local income and insurance allocations.
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Abstract Background Heart disease is a common cause of mortality and a major contributor to healthcare expenditure worldwide. A tertiary government hospital in the Philippines instituted an Acute Heart Failure Pathway to streamline the management of acute heart failure in its emergency department in 2022. This study aimed to determine the cost of the initial 24-hour emergency room inpatient management of acute heart failure guided by the pathway among adult Filipinos from a payor’s perspective. Purpose This study aimed to determine the costs of streamlined management of acute heart failure to provide a benchmark cost, and aid in the analysis of cost effectiveness of current recommendations. The ultimate goal of this study was to guide health policy and financing in the local setting. Methods A bottom-up, micro-costing methodology was used for the study. Data on patient characteristics and resource utilisation was extracted from: 1. A database maintained by the study group which contained anonymised data on patients referred to the service of cardiology via the heart failure pathway, and 2. Medical records of adult Filipino patients admitted for acute heart failure and referred to the service of cardiology via the pathway in the emergency room from December 2022 to May 2023. The cost of care was calculated using data on resource utilisation consisting of medications and laboratory tests, and data on prices retrieved from patient billing statements, hospital citizen’s charter, and drug price reference index released by the Philippine Department of Health. Results A total of 236 patients were included in the study. The mean cost of care of the initial 24-hour inpatient emergency room management of acute heart failure was USD 140.03 (SD +/- USD 41.2) per patient. Heart Failure Pathway-related diagnostics accounted for 88.35% of the mean cost, while Heart Failure Pathway-related medications accounted for 11.64%. The most frequently ordered medication among included patients were diuretics (ordered in 87.71% of the study population), which had a mean contribution of USD 2.465 (SD +/- USD 1.49) or 1.68% of the mean cost per patient. Conclusion The mean cost of the initial 24-hour emergency room management of acute heart failure in a tertiary hospital in the Philippines was USD 140.03 (SD +/- USD 41.2). The initial cost of management amounted to 51.8% of the National Health Insurance Program allocation per admission in 2023, and at least 45% of the monthly equivalent of a Filipino adult’s minimum wage. Diagnostics were the primary cost driver of the estimated mean cost. Further investigation into the effectiveness of each measure in the management of heart failure could identify important components of management and reduce cost of care by exclusion of components found to have no significant benefit.Table1.Patient Characteristics Table2.Diagnostics and Therapeutics
Joson et al. (Sat,) reported a other. The mean cost of the initial 24-hour emergency room management of acute heart failure was USD 140.03, primarily driven by diagnostics at 88.35% of costs.