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Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study
Kun Yun Lee1, Tiong Kiam Ong2, Ee Vien Low3
1Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Insights
Calculating the hospitalization cost for percutaneous coronary intervention (PCI) in Malaysia reveals that consumables are the main expense. Tailored costing methods are crucial for economic evaluations in countries with limited data.
Area of Science:
- Health Economics
- Cardiovascular Disease Management
- Healthcare Costing
Background:
- Economic evaluations are hindered by poor cost data quality in low- and middle-income countries.
- Coronary artery disease prevalence is rising in Malaysia, necessitating cost data for cardiac service planning.
Purpose of the Study:
- To determine the hospitalization cost of percutaneous coronary intervention (PCI).
- To adapt a data collection method for settings with limited cost data availability.
Main Methods:
- A cross-sectional costing study using a top-down approach was conducted from January to June 2014.
- Cost items for PCI services were identified, valued, and calculated across five public cardiac centers.
- Unit costs were estimated for cardiac ward admission and cardiac catheterization utilization.
Main Results:
- Average hospitalization costs for elective PCI ranged from RM11,471 (US$3,186) to RM14,465 (US$4,018).
- Percutaneous coronary intervention consumables represented the largest cost component in all participating centers.
- The center with a daycare facility reported the lowest admission and total hospitalization costs.
Conclusions:
- Comparative cost data across centers provide valuable insights for healthcare service planning.
- Exploring alternative procurement for PCI consumables may lead to cost reductions.
- Customized costing methodologies are effective for economic evaluations in data-limited environments.
Objectives:
Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability.
Design:
This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates.
Setting:
Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions.
Participants:
The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded.
Primary And Secondary Outcome Measures:
The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost.
Results:
The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost.
Conclusions:
Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations.
Registration:
Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR).
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