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

Open Access

Budget Impact Analysis of the Proposed PhilHealth Case Rates for Acute Coronary Syndrome in the Philippines

Bernadette A. Tumanan-Mendoza, Victor L. Mendoza, Felix Eduardo R. Punzalan, Noemi S. Pestaño, April Ann A. Bermudez-delos 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. Lahoz, Neil Wayne C. Salces
Dec 2022 DOI 10.69944/pjc.a0346a915f

Abstract

OBJECTIVE: This study aimed to determine the budget impact of the proposed revised  PhilHealth case rate packages for acute coronary syndrome (ACS). 

METHODS: This budget impact analysis used the static approach or cost calculator modeling  method. The prevalence of hospitalization for coronary artery disease in all PhilHealth-accredited  hospitals in the country in 2017 and the data from the ACS registry project of the Philippine Heart  Association were used in this study. The study multiplied the present PhilHealth coverage with  the number of ACS hospitalization claims to come up with the total cost of ACS hospitalization  in the next three years with the assumptions that the eligible population and the ACS PhilHealth  case rates will remain constant for these years. The future ACS hospitalization costs were also  determined if the proposed case rates were used rather than the current PhilHealth case rates.  The cost of re-admissions was considered as savings in hospitalization cost (due to prevention of  admissions if the appropriate interventions were given) and were deducted from the future total  cost of ACS hospitalizations. 

RESULTS: The annual total ACS hospitalization cost using the current case rates was Php  1,134,683,000. Using the proposed case rates, the total hospitalization costs over five years was  Php 2,653,019,000 in the first year (proposed case rates implemented to only 20% of the ACS  patients) and increased to Php 8,726,364,000 by year 5 (full implementation of the proposed  case rates or to 100% of ACS patients). This resulted in a lower incremental cost in the first  year of implementation compared with a less gradual implementation over 3 years. The total  incremental costs would amount to PHP7.6 billion for full implementation. 

CONCLUSION: The study provided the budget impact of the proposed revised ACS case rates.  The incremental cost is relatively huge, however the benefits of providing coverage of guideline directed therapy including invasive strategies for ACS must be considered. 

References
  1. Sullivan SD, Mauskopf JA, Augustovski F, Caro JJ, Lee KM, Minchin M, Orlewska E, Penna P, Rodriguez Barrios JM, Shau WY. ISPOR Task Force Report Budget Impact
  2. Analysis – Principles of Good Practice: Report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value in Health 2014; 17:5-14.
  3. Mauskopf JA, Sullivan SD, Annemans L, Caro J, Mullins CD, Nuijten M, Orlewska E, Watkins J, Trueman P. Principles of Good Practice for Budget Impact Analysis: Report of the ISPOR Task Force on Good Research Practices – Budget Impact Analysis. Value in Health 2007; 10:336-347.
  4. 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. PJC 2020; file:/// Users/BATM/Downloads/8_The%20Epidemiologic%20 Burden%20of%20Hospitalization%20 for%20Coronary%20 Artery.pdf. (accessed December 27, 2021).
  5. 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).
  6. Mauskopf J. Budget-Impact Analysis. Encyclopedia of Health Economics. 2014; doi:10.1016/B978-0-12-375678- 7.01423-1.
  7. Beltejar-Pimental LMV, Iboleon-Dy MA, Caole-Ang I. Obstructive CAD in Filipino Women vs Men Diagnosed with ACS in the Philippine ACS Registry. PJC 2017; 7:31-44.
  8. 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).
  9. PhilHealth. List of Procedure Case Rates (Revision 1.0). https://www.philhealth.gov.ph/circulars/2015/annexes/ circ08_2014/Annex2_ListofProcedureCase RatesRevision1. pdf (accessed October 10, 2021).
  10. Philippine Health Insurance Corporation. PhilHealth Circular No. 27 s-2005. https://www.philhealth.gov.ph/ circulars/2005/circ27_2005.pdf (accessed December 13, 2021).
  11. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS Jr, Nnacheta LC, Rao SV, Sabik JF, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/ SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;00:000-000.
  12. 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; 39:119-177.
  13. The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST segment elevation of the European Society of Cardiology (ESC). 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367.
  14. Philippine Statistics Authority. Annual Family Income is Estimated at PhP 313 Thousand, on Average, In 2018. https://psa.gov.ph/income-expenditure/fies/title/ Annual%20Family%20Income%20is%20Estimated%20 at%20%20PhP%203 13%20Thousand%2C%20on%20 Average%2C%20In%202018. (accessed January 4, 2022).
  15. PhilHealth Circular No.0035 s.2013. https://www.philhealth. gov.ph/circulars/2013/circ35_2013.pdf. (accessed January 8, 2022).11. Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021;145:e18–e114.
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