Vol. 49 | No. 1 | January-June 2021 Back

Open Access

The Economic Burden of Hospitalization for Cardiac Arrhythmias Requiring Implantable Cardioverter Defibrillator and Radiofrequency Ablation Among Adult Filipinos—Its Clinical and Equity Implications and Budget Impact Analysis of Proposed Revised PhilHealth Case Rates for Cardioverter-Defibrillator Implantation and Radiofrequency Ablation

Bernadette A. Tumanan-Mendoza, Victor L. Mendoza, Eden A. Gabriel, Giselle G. Gervacio, Erdie C. Fadreguilan, Michael-Joseph F. Agbayani, Gladys Ruth S. David, Luigi Pierre S. Segundo, Carlos E. De Las Llagas, Magdalena J. Lagamayo, Felix Eduardo R. Punzalan, April Ann A. Bermudez-delos Santos, Noemi S. Pestaño
Jun 2021 DOI 10.69944/pjc.6f463ba151

Abstract

BACKGROUND: Radiofrequency ablation (RFA) is the recommended treatment of choice for supraventricular tachycardia (SVT), whereas implantable cardioverter-defibrillator (ICD) is recommended for patients at high risk for sudden death due to ventricular tachycardia/fibrillation. Radiofrequency ablation has been proven to improve the quality of life of patients with SVT, whereas an ICD has been shown to reduce mortality among patients at risk for sudden cardiac death. Both procedures are expensive and usually beyond the reach of the average Filipino patient.

OBJECTIVES: The objectives are to (1) determine the cost of hospitalization for cardiac arrhythmias that require RFA and cardioverter-defibrillator implantation in the Philippines, (2) propose revised Philippine Health Insurance Corporation (PhilHealth) benefit packages for both procedures, and (3) determine the budget impact of the proposed revised packages.

METHODS: Hospitalization costs were obtained for both RFA and cardioverter-defibrillator implantation from two government tertiary care hospitals. A range of hospitalization costs involving possible lower and higher cost scenarios was estimated. Based on these estimates and the yearly number of arrhythmias that require these procedures, revised benefit packages for both RFA and cardioverter-defibrillator implantation were proposed to PhilHealth. The budget impact analysis for the first 3 and 5 years of implementation of these revised packages was subsequently calculated.

RESULTS: The estimated hospitalization costs for RFA ranged from Philippine pesos (PHP) 248,485 to 310,480, whereas for cardioverter-defibrillator implantation, the costs ranged from PHP 509,122 to 581,940. These amounts are greatly disparate from the present PhilHealth coverages, which are PHP 9700 and 18,000 for RFA and cardioverter-defibrillator implantation, respectively. Based on these hospitalization costs, the proposed RFA benefit package is PHP 275,000 to 310,000, whereas for an ICD benefit package, PHP 513,000 to 576,000 is proposed. The incremental cost of more than PHP 300 million for RFA and more than PHP 700 million for an ICD is distributed for the next 3 or 5 years of implementation for these benefit packages, respectively.

CONCLUSION: The present PhilHealth case rates for both RFA and cardioverter-defibrillator implantation are greatly underestimated, which probably is the reason for their underutilization. There is a need to revise these case rates with due consideration of their actual hospitalization costs to lessen inequity in accessing these procedures.

KEYWORDS: radiofrequency ablation, implantable cardioverter-defibrillator, PhilHealth

References
  1. Shapira AR. Catheter ablation of supraventricular arrhythmias and atrial fibrillation. Am Fam Physician 2009;80:1089-1094.
  2. Calkins H, Kumar VKA, Francis J. Radiofrequency catheter ablation of supraventricular tachycardia. Indian Pacing Electrophysiol J 2002;2:45-49.
  3. Katritsis DG, Zografos T, Katritsis GD, et al. Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. Europace 2017;19:602-606.
  4. Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/ HRS guideline for the management of adult patients with supraventricular tachycardia. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2016;133:e506-3574. doi: 10.1161/ CIR.0000000000000311.
  5. Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC) Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2020;41:655-720. doi:10.1093/eurheartj/ehz467.
  6. Epstein, AE, DiMarco, JP, Ellenbogen, KA., et al. ACC/AHA/ HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. A report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 2008;117:e350-e408.doi: 10.1161/CIRCUALTIONAHA.108.189742.
  7. The revised implementing rules and regulations of the National Health Insurance Act of 2013 (RA 7875 as Amended by RA 9241 and 10606). https://www.philhealth. gov.ph/about_us/IRR_NHIAct_2013.pdf. Accessed June 7, 2020.
  8. PhilHealth. 2017 Stats & Charts. https://www.philhealth. gov.ph/about_us/statsncharts/snc2017.pdf. Accessed June 7, 2020.
  9. PhilHealth. 2018 Stats & Charts. https://www.philhealth. gov.ph/about_us/statsncharts/snc2018.pdf. Accessed June 7, 2020.
  10. 2016 PhilHealth Relative Value Scale codes/procedures. https://www.philhealth.gov.ph/circulars/2013/annexes/ circ35_2013/Annex2_ListOfProcedureCaseRates.pdf. Accessed June 7, 2020.
  11. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford, UK: Oxford University Press; 2015.
  12. Sullivan SD, Mauskopf JA, Augustovski F, et al. Budget impact analysis—principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health 2014;17:5-14.
  13. Philippine Statistics Authority Philippine National Health Accounts. Total health expenditures grew by 8.0 percent in 2017. https://psa.gov.ph/pnha-press-release/ node/136135. Accessed June 9, 2020.
  14. Philippine Statistics Authority Philippine National Health Accounts. Total health expenditures grew by 8.3 percent in 2018. https://psa.gov.ph/pnha-press-release/ node/144466. Accessed June 9, 2020.
  15. Philippine Statistics Authority. Annual family income is estimated at PHP313 thousand, on average, in 2018. https://psa.gov.ph/content/annual-family-income estimated-php-313-thousand-average-2018. Accessed June 8, 2020.
  16. Gervacio-Domingo G, Punzalan FE, Amarillo ML, Dans A. Sudden unexplained death during sleep occurred commonly in the general population in the Philippines: a substudy of the National Nutrition and Health Survey. J Clin Epidemiol 2007;60:567-571.
  17. Gervacio-Domingo G, Isidro J, Tirona J, et al. The Brugada type 1 electrocardiographic pattern is common among Filipinos. J Clin Epidemiol 2008;61:1067-1072.
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