Primary Causes and Direct Medical Cost of Heart Failure Among Adults Admitted with Acute Decompensated Heart Failure in a Public Tertiary Hospital, Kenya

Background: Heart failure (HF) is a major contributor to cardiovascular morbidity and mortality. Adversely impacting health outcomes in Kenya and other developing countries, data on the direct medical cost of HF hospitalization remain limited. Methods: This was a prospective study conducted at Moi Teaching and Referral Hospital. Patients with HF were identified by sequential medical chart abstraction. Primary causes were extracted from echocardiogram reports and adjudicated by a cardiologist. Direct medical cost of hospitalization was derived using activity-based and micro-costing methods, adopting payers' system perspective. Drivers of overall cost were explored using linear regression models. Results: 142 participants were consecutively recruited from September to November 2022. 51.4% were females, and the mean age was 54 (SD 20). The leading primary causes were cor pulmonale (CP), 28.9%; dilated cardiomyopathy (DCM), 26.1%; rheumatic heart disease (RHD), 19.7%; hypertensive heart disease (HHD), 16.9%; ischaemic heart disease (IHD), 6.3%; and pericardial disease (PD), 2.1%. Overall direct cost of HF hospitalization was KES 11,470.94 (SD 8,289.57) [USD 93.49 (67.56)] per patient per day, with the mean length of hospital stay of 10.1 (SD 7.1). RHD incurred the highest costs, KES 15,299.08 (SD 13,196.89) [USD 124.70 (107.56)] per patient per day; IHD, KES 12,966.47 (SD 6656.49) [USD 105.68 (54.25)]; and DCM, KES 12,268.08 (SD 7,816.12) [USD 99.99 (63.71)]. The cost of medications was the leading driver, β = 0.56 (0.55 - 0.56), followed by inpatient fees, β = 0.27 (0.27 - 0.28), and laboratory investigations, β = 0.19 (0.18 - 0.19). Conclusion: Cor pulmonale, CM, RHD, and HHD were the major causes of HF. The overall direct medical cost of hospitalization was extremely expensive compared with the Kenyan average monthly household income per capita. Widespread comprehensive health insurance coverage is therefore recommended to cushion families against such catastrophic health expenditures besides public health measures aimed at addressing primary causes of HF.