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Frugal Innovations for Delivering Child Cardiac Care in India
Wasan Kumar1,2, Sara J Singer3,4, Kanwaljeet J S Anand5,6,7
1Researcher, Stanford University School of Medicine, Stanford, CA, USA.
NEJM Catalyst Innovations in Care Delivery
|July 8, 2026
Summary
Congenital heart defect surgeries in India are significantly more affordable at a charitable hospital compared to a private one. Outcomes were comparable, suggesting cost-effective models can improve access to pediatric cardiac care.
Area of Science:
- Global Health
- Pediatric Cardiology
- Health Economics
Background:
- Congenital heart defects (CHDs) impact 240,000 Indian newborns annually.
- Access to lifesaving pediatric cardiac surgery is limited for rural populations due to cost.
- Comparative analysis is needed to understand cost and outcome variations in CHD care.
Purpose of the Study:
- To compare the costs and health outcomes of pediatric cardiac surgery in India.
- To identify opportunities for improving congenital cardiac care delivery in low- and middle-income countries.
- To evaluate two distinct healthcare systems: a philanthropic model versus a private, fee-for-service model.
Main Methods:
- Time-driven activity-based costing was used to quantify hospital-based care costs.
- Direct costs were collected from Sanjeevani Hospitals (charitable) and Amrita Institute of Medical Sciences (private).
- Surgies for Tetralogy of Fallot (TOF) and Ventricular Septal Defect (VSD) were analyzed using Risk Adjustment for Congenital Heart Surgery (RACHS) scores.
Main Results:
- Average costs at Sanjeevani Hospitals were $2132 (TOF) and $2038 (VSD), versus $4645 for both at Amrita Institute.
- Mortality rates were comparable: 2.96% (846 surgeries) at Sanjeevani Hospitals vs. 1.91% (629 surgeries) at Amrita Institute (P=0.2).
- Lower costs at Sanjeevani Hospitals were linked to family involvement and reduced administrative expenses.
Conclusions:
- Scalable, cost-effective pediatric cardiac surgery models exist in India.
- Addressing financial barriers can enhance access to essential surgeries, improving health equity.
- Improved access leads to better clinical and socioeconomic outcomes in global health contexts.
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