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Cost of Congenital Heart Disease Hospitalizations in Canada: A Population-Based Study
Andrew S Mackie1, Dat T Tran2, Ariane J Marelli3
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Insights
Congenital heart disease (CHD) inpatient costs in Canada are rising, especially for adults with complex conditions. While children incur higher costs, adult costs are increasing at a faster rate, necessitating resource reallocation.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Rising prevalence of congenital heart disease (CHD) and frequent late complications.
- Limited understanding of the impact of CHD on healthcare costs.
- Need to describe inpatient costs associated with CHD in Canada.
Purpose of the Study:
- To describe inpatient costs related to congenital heart disease (CHD) in Canada.
- To analyze trends in CHD-related healthcare expenditures.
- To identify demographic and clinical factors influencing CHD costs.
Main Methods:
- Observational retrospective cohort study using the Canadian Institute for Health Information Discharge Abstract Database (2004-2014).
- Inclusion of hospitalizations with primary or secondary CHD diagnoses (ICD-10 Q20.0-Q26.9).
- Utilized CIHI patient cost estimates, inflated to 2016 Canadian dollars.
Main Results:
- Annual CHD inpatient costs increased by 21.6% from CAD$99.7 million in 2004 to $121.2 million in 2013.
- Costs were higher in children than adults, but increased more rapidly in adults (4.5%/year vs 0.7%/year).
- Adults' share of costs rose from 38.2% to 45.8%; costs increased most in adults with complex CHD (7.2%/year).
Conclusions:
- Inpatient CHD costs are rising significantly, independent of inflation, particularly in adults with complex CHD.
- While children still represent a larger portion of CHD costs, the rate of increase is notably higher in the adult population.
- Findings underscore the importance of resource allocation for the growing inpatient needs of adults with CHD.
Background:
The prevalence of congenital heart disease (CHD) is rising, and late complications are common. The impact of these factors on health-care costs is not well understood. We sought to describe inpatient CHD costs in Canada.
Methods:
We conducted an observational retrospective cohort study. The Canadian Institute for Health Information (CIHI) Discharge Abstract Database was used for all Canadian provinces, except Quebec, between April 2004 and March 2014. We included hospitalizations with a main diagnosis of CHD (International Classification of Diseases, 10th revision, codes Q20.0-26.9) and hospitalizations having CHD as a secondary diagnosis if the main diagnosis was a comorbid condition related to CHD. CIHI patient cost estimates were used to provide dollar values. Costs were inflated to 2016 Canadian dollars.
Results:
Among 59,917 hospitalizations, annual CHD costs increased by 21.6% from CAD$99.7 million (95% confidence interval [CI], $89.4-$110.1 million) in 2004 to $121.2 million (95% CI, $112.8-$129.6 million) in 2013 (P < 0.001). Costs were higher for children compared with adults. However, the cost increase was greater in adults (4.5%/y; P < 0.001) than in children (0.7%/y; P = 0.006). Adults accounted for 38.2% of costs in 2004 vs 45.8% in 2013 (P = 0.002). Costs increased most among adults with complex CHD (7.2%/y; P = 0.001). Adult men accounted for greater increases in costs relative to women (P < 0.001). Length of stay was unchanged over time.
Conclusions:
Inpatient CHD costs are increasing independent of inflation, particularly among adults with complex lesions. Although children still account for greater inpatient CHD costs, a larger increase was observed among adults. These data are important in allocating inpatient resources for adults with CHD.
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