Vol. 50 | No. 2 | July-December 2022 Back

Open Access

Proposed Case Rates for Acute Coronary Syndrome and Budget Impact Analysis: Executive Summary

Bernadette A. Tumanan-Mendoza, Victor L. Mendoza, Felix Eduardo R. Punzalan, Noemi S. Pestaño, April Ann A. Bermudez-de los Santos, Eric Oliver D. Sison, Eugenio B. Reyes, Karen Amoloza-de Leon, Nashiba M. Daud, Maria Grethel C. Dimalala-Lardizabal, Orlando R. Bugarin, Rodney M. Jimenez, Domicias L. Albacite, Ma. Belen A. Balagapo, Elfred M. Batalla, Jonathan James G. Bernardo, Helen Ong Garcia, Amibahar J. Karim, Gloria R. LahozNeil Wayne C. Salces
Dec 2022 DOI 10.69944/pjc.12c9d0968b

Abstract

BACKGROUND: Coronary artery disease is the leading cause of death in the Philippines and can present as acute coronary syndrome. Hospitalization for ACS has epidemiologic and economic burden. In fact, last 2017, there were 1.52% or 152 admissions for every 10,000 hospitalized patients for medical conditions in PhilHealth-accredited hospitals locally. However, coronary angioplasty was performed in only less than 1% of these cases mainly because of its cost and the out-of-pocket expense that the treatment entail, when primary percutaneous intervention has been proven to be effective in reducing mortality in STEMI and early invasive intervention performed during index hospitalization for NSTEMI is likewise recommended. Moreover, there is a big disparity between the current case rates for ACS for medical therapy alone and for invasive intervention compared to the actual ACS hospitalization cost.

OBJECTIVES: 1) To propose revisions to the current PhilHealth case rates for acute coronary syndrome (ACS); and 2) To determine the budget impact of the proposed ACS case rates.

METHODS: The Philippine Heart Association with the assistance of a technical working group undertook the study. A panel of experts composed of general and invasive cardiologists from Luzon, Visayas, and Mindanao was formed. The ACS hospitalization costs based on the recent study by Mendoza were presented and discussed during the focus group discussions with the panelists. Issues pertinent to their localities that may affect the costs were discussed. The proposed revised costs on the particular ACS conditions and therapeutic regimens were then voted and agreed upon. A budget impact analysis of the proposed case rates was then performed.

RESULTS: The proposed case rates for ACS ranged from Php 80,000 (for low risk unstable angina given medical treatment) to Php 530,000 (for ST-elevation myocardial infarction initially given a thrombolytic agent then underwent PCI which necessitated the use of three stents). The budget impact analysis showed that the proposed ACS rates would require an additional PHP 1.5 billion to 2.3 billion during the first year of a 3- versus 5-year implementation period, respectively. The period of implementation will be affected by budgetary constraints as well as the availability of cardiac catheterization facilities in the country.

CONCLUSION: The proposed revised PhilHealth hospitalization coverage for ACS is more reflective or realistic of the ACS hospitalization costs in contrast with the current PhilHealth case rates. The corresponding budget impact analysis of these proposed case rates showed that PHP 7.6 billion is needed for full implementation. However, given the budget constraints, the percentage of the total costs for the first and subsequent years of implementation may be modified.

References
  1. Epidemiology Bureau Department of Health. The 2019 Philippine Health Statistics. https://doh.gov.ph/sites/ default/files/publications/2019PHS_Final_092121.pdf. Accessed December 27, 2021.
  2. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2019;40:87–165. doi: 10.1093/eurheartj/ehy394.
  3. Bermudez-Delos Santos AA, Tumanan-Mendoza BA, Mendoza VL, et al. Epidemiologic burden of hospitalization for coronary artery disease among adults aged 19 years and above in the Philippines. Philipp J Cardiol 2020. file:/// Users/BATM/Downloads/8_The%20Epidemiologic%20 Burden%20of%20Hospitalization%20for%20Coronary%20 Artery.pdf. Accessed December 27, 2021.
  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. 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.
  6. 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.
  7. PhilHealth. List of medical case rates. Updated February 2017. https://www.philhealth.gov.ph/circulars/2017/ annexes/0019/AnnexA-MedicalCaseRates.pdf. Accessed February 10, 2021.
  8. PhilHealth. List of procedure case rates (revision 1.0). https://www.philhealth.gov.ph/circulars/2015/annexes/ circ08_2014/Annex2_ListofProcedureCaseRatesRevision1. pdf. Accessed October 10, 2021.
  9. Philippine Health Insurance Corporation. PhilHealth circular no. 27 s-2005. https://www.philhealth.gov.ph/ circulars/2005/circ27_2005.pdf. Accessed December 13, 2021.
  10. Beltejar-Pimental LMV, Iboleon-Dy MA, Caole-Ang I. Obstructive CAD in Filipino women vs men diagnosed with ACS in the Philippine ACS Registry. Philipp J Cardiol 2017;7:31–44.
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