Heart failure outpatient costs of care in a Philippine tertiary government hospital

Introduction Heart failure (HF) is a major health and economic burden in the Philippines, where most outpatient medical expenses are paid out-of-pocket. Limited data exist on the costs of HF outpatient care, which are essential for guiding government reimbursement policies. This study estimates the costs of diagnostics and medications prescribed for HF outpatients in a tertiary government hospital. Methods This single-center cohort study reviewed medical records of adult outpatients diagnosed with heart failure with reduced ejection fraction discharged between December 2022 and May 2023. Data on clinical characteristics, employment status, income, and direct medical costs (diagnostics and medications) were collected. Cost estimates were based on price lists for privatized versus subsidized diagnostics, and generic versus branded medications, assuming full adherence. A bottom-up cost analysis was conducted using three-month post-discharge follow-up data. Results A total of 100 patients were analyzed (mean age: 53 ± 11.6 years; 73% male). The most common HF etiologies were ischemic heart disease, hypertension, and methamphetamine-associated cardiomyopathy. Among them, 51% were employed, 63% belonged to households with ≥5 members, and the median monthly income was €167.00 (IQR €100.00–€296.17). Median diagnostic costs per patient declined from month 1 (€19.21 vs. €31.27) to month 3 (€7.52 vs. €15.03), primarily due to fewer tests ordered. Echocardiography comprised 41–43% of diagnostic expenses. The median medication cost per patient remained stable over three months and ranged from €222.16 [generic: IQR €134.60–€332.65] to €476.52 [branded: IQR €305.26–€698.32]. Angiotensin receptor–neprilysin inhibitors (33–34%) and SGLT-2 inhibitors (7–14%) were the primary medication cost drivers. The overall median monthly cost per patient was €249.34 (subsidized: IQR €148.96–€349.28) vs. €495.31 (privatized/branded: IQR €354.21–€741.37). Conclusion HF outpatient care costs exceed patient income, underscoring the need for government support to improve affordability, reduce hospitalizations, and enhance patient outcomes