Vol. 50 | No. 1 | January-June 2022 Back

Open Access

Cost of Hospitalization for Acute Coronary Syndrome in the Philippines

Victor L. Mendoza
Jun 2022 DOI 10.69944/pjc.4cc0be1178

Abstract

INTRODUCTION: Acute coronary syndrome (ACS), specifically myocardial infarction, accounted  for approximately 41% of deaths due to coronary artery disease in 2013. A large number of  Filipinos are affected by ACS; thus, it is important to determine its hospitalization cost. The  study objectives were to (1) define the hospital care pathways for ACS; (2) determine the  resources used; (3) estimate the hospitalization cost for uncomplicated ACS; and (4) determine  the difference between the estimated hospitalization cost and the coverage provided by the  Philippine Health Insurance Corporation (Philhealth). 

METHODS: A cost analysis study was done. Mixed qualitative and quantitative data collection  tools consisted of consultations with local cardiologists, key informant interviews, and self administered survey forms. Sensitivity analysis was performed through scenario analysis. 

RESULTS: The ACS hospital care pathway was derived after consultative meetings with invasive  and noninvasive cardiologists. Using this pathway, the resources used for ACS hospitalization  were identified, and the total hospitalization costs were calculated. For medical treatment alone,  the costs were approximately Philippine peso (₱) 67,000 to ₱90,000, whereas for medical  treatment with percutaneous coronary intervention (PCI), the costs were approximately ₱265,000  to ₱425,500. In comparison, Philhealth’s maximum coverage for ACS with PCI is ₱39,750. 

CONCLUSION: There is variation in the ACS hospitalization cost, depending on the  management strategy used and the type of hospital where a patient is confined. Medical plus  reperfusion with PCI increases the cost four to five times when compared with medical treatment  alone. Huge out-of-pocket expense is demonstrated because of the large discrepancy between  the actual hospitalization costs to Philhealth’s ACS coverage. 

KEYWORDS: acute coronary syndrome, cost analysis, Philhealth 

 

References
  1. Philippine Statistics Authority. Deaths in the Philippines, 2016. https://psa.gov.ph/content/deaths-philippines-2016. Accessed April 15, 2019.
  2. The 2013 Philippine Health Statistics. Epidemiology Bureau Department of Health. https://www.doh.gov.ph/sites/ default/files/publications/2013PHScompressed_0.pdf. Accessed September 13, 2019.
  3. Simons M, Alpert JS. Acute coronary syndrome: terminology and classification. UpToDate. https://www. uptodate.com/contents/acute-coronary-syndrome terminology-and-classification. Accessed May 8, 2019.
  4. Gibson CM, Carrozza JP, Laham RJ. Primary percutaneous coronary intervention versus fibrinolysis in acute ST elevation myocardial infarction: clinical trials. UpToDate. https://www.uptodate.com/contents/primary percutaneous-coronary-intervention-versus-fibrinolysis in-acute-st-elevation-myocardial-infarction-clinical trials?topicRef=55&source=see_link. Accessed April 17, 2019.
  5. American College of Cardiology/American Heart Association Task Force on Guidelines.2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. Circulation 2008;117:296–329.
  6. Gibson CM, Carrozza JP, Laham RJ, Pinto DS. Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: determinants of outcome.
  7. UpToDate. https://www.uptodate.com/contents/primary percutaneous-coronary-intervention-in-acute-st-elevation myocardial-infarction-determinants-of-outcome.Accessed April 17, 2019.
  8. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2017;00:1–66. doi:10.1093/eurheartj/ehx393.
  9. Gibson CM, Corbalan R. Fibrinolysis for acute ST elevation myocardial infarction: initiation of therapy. UpToDate. https://www.uptodate.com/contents/fibrinolysis-for-acute-st -elevation-myocardial-infarction initiation-oftherapy?sectionName=INITIATION%20OF%20 THERAPY&topicRef=72&anchor=H69239839&source= see_link#H69239839. Accessed April 17, 2019.
  10. Philippine Statistics Authority. Total health expenditures grew by 8.0 percent in 2017. https://psa.gov.ph/pnha press-release. Accessed April 10, 2019.
  11. Philippine Statistics Authority. Each Pinoy spent 5,859 for health in 2014. https://psa.gov.ph/content/each-pinoy spent-5859-health-2014. Accessed April 15, 2019.
  12. Philippine Statistics Authority. Total health expenditures grew by 10.5 percent in 2016. https://psa.gov.ph/national health-accounts-press-releases. Accessed April 15, 2019.
  13. Philhealth. Annual report 2017. https://www.philhealth.gov. ph/about_us/annual_report/ar2017.pdf. Accessed April 16, 2019.
  14. Philhealth. Philhealth Circular No. 0002, s-2013. https:// www.philhealth.gov.ph/circulars/2013/circ02_2013.pdf. Accessed April 16, 2019.
  15. Tumanan-Mendoza BA, Morales DD, Mendoza VL. Cost analysis for the management of acute coronary syndrome using different quality of care indicators. Acta Med Philipp 2009; 43:15–22.
  16. Reference Exchange Rate Bulletin, Treasury Department, BSP. Daily pesos per U.S. dollar rate Sep-18 to Sep-19 (average July 2019; 1 US$ = ₱51.143). http://www.bsp. gov.ph/statistics/keystat/day99.htm. Accessed September 8, 2019.
  17. Philhealth. List of medical case rates (updated February 2017). https://www.philhealth.gov.ph/circulars/2017/ annexes/0019/AnnexA-MedicalCaseRates.pdf. Accessed April 16, 2019.
  18. Philippine Statistics Authority. Average family income in 2015 is estimated at 22 thousand pesos monthly (results from the 2015 family income and expenditure survey). https://psa.gov.ph/content/average-family-income-2015- estimated-22-thousand-pesos-monthly-results-2015- family-income. Accessed April 17, 2019.
  19. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015.
  20. Wong LP. Focus group discussion: a tool for health and medical research. Singapore Med J 2008; 49:256–261.
  21.  Swiss TPH (Swiss Tropical and Public Health Institute). Key Area of Activity (KAA-10) “Society, Culture and Health.” https://www.swisstph.ch/fileadmin/user_upload/SwissTPH/ Topics/Society_and_Health/Focus_Group_Discussion_ Manual_van_Eeuwijk_Angehrn_Swiss_TPH_2017.pdf. Accessed October 2, 2019.
  22.  Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the management of patients with non–ST-elevation acute coronary syndromes. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;130:e344–e426.
  23. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation—web addenda. Eur Heart J 2017;00:1–8. doi:10.1093/eurheartj/ehx393.
  24. Philippine Heart Association, Inc. and Philippine College of Cardiology. 2014 PHA clinical practice guidelines for the diagnosis and management of patients with coronary heart disease. ASEAN Heart J 2016;24:27–78.
  25. Wenger NK, Rosenson RS, Braun LT. Cardiac rehabilitation: indications, efficacy, and safety in patients with coronary heart disease. UpToDate. https://www. uptodate.com/contents/cardiac-rehabilitation-indications efficacy-and-safety-in-patients-with-coronary-heart disease?search=cardiac-rehabilitation-indications eff&source=search_result&selectedTitle=2~150&usage_ type=default&display_rank=2. Accessed September 22, 2019.
  26. Mani K, Lundkvist J, Holmberg L, Wanhainen A. Challenges in analysis and interpretation of cost data in vascular surgery. J Vasc Surg 2010;51:148–154.
  27. Thompson SG, Barber JA. How should cost data in pragmatic randomized trials be analyzed? BMJ 2000;320:1197–2000.
  28. Jan et al. Predictors of high-cost hospitalization in the treatment of acute coronary syndrome in Asia: findings from EPICOR Asia. BMC Cardiovasc Disord 2018;18:139. https://doi.org/10.1186/s12872-018-0859-4.
  29. Philhealth, 2019. Case rates search. https://crs.philhealth. gov.ph. Accessed September 13, 2019.
License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.