Cost of a routine (planned) cardiac by-pass surgery at the National Hospital of Sri Lanka

Background: Non-communicable disease (NCD) has become a major challenge in Sri Lanka. Over the last 40 years, ischemic heart disease (IHD) has been identified as one of the leading causes of NCD deaths in Sri Lanka. Coronary artery bypass graft (CABG) is a revascularization procedure that has been identified as an effective method for managing a patient with IHD. Therefore, estimating the approximate cost of CABG surgery in a public hospital would help in economic evaluations and managerial decision-making in public sector investments.Objective: To estimate the approximate cost of an uncomplicated routine (planned) cardiac bypass surgery at the National Hospital of Sri Lanka (NHSL), Colombo.Methods: This study was primarily based on secondary data. The data required for costing the procedure was extracted from 52 BHTs of patients who underwent CABG surgery at the NHSL during the last three months of the year 2019. Extracted data was used to determine the costing elements of each cost center. Direct and indirect cost centers were identified, and the cost of each center was determined by apportioning the available cost data by the step-down method using a weighted factor where applicable.Results: The approximate cost of an uncomplicated CABG was Rs. 1.3 million per patient. Out of the total cost, 89% (Rs. 1.16 million) was expended on direct labor as salaries of different categories of staff. A major portion of it (56%) was spent on ICU care (Rs. 0.654 million) followed by post-surgical care at the ward settings (33.9%, Rs. 0.393 million). The highest cost of the material was recorded at the theatre which was 6% of the total cost (Rs. 78,960.00). The cost of total overheads was Rs. 29,517.00 which was about 2.2% of the total. Conclusion: Although the approximate cost of a routine uncomplicated CABG surgery was Rs.1.3 million ($ 7,027) as of December 2019 at the National Hospital of Sri Lanka, compared to more developed countries this is a fairly low cost. However, when the differences between health system organization and per capita health expenditure are concerned, this is quite evident to claim that the Sri Lankan health system has low-cost but effective models of delivering its care to people.