Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.

The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective.Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014) in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule.The median age was 8.2 months (IQR: 3.0- 36.0 months). Most families belonged to upper middle (43.0%) and lower middle (35.7%) socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139) [I$ 11989 (IQR: 9696-15804)], which was 0.93 (IQR: 0.52-1.49) times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50) and job-days was 15 (IQR: 11-24). Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery.Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families

Patient Characteristics.

<p>* Details of ICU stay were not available for 24 subjects at baseline.</p><p>^# Details of Ventilation time were not available for 21 subjects at baseline.</p><p>^$ Risk Adjustment for Congenital Heart Surgery</p><p>Patient Characteristics.</p

Relationship between risk factors and family indirect cost of congenital heart surgery.

<p>¹Adjusted for age and annual income;</p><p>²adjusted for RACHS, age, and annual income;</p><p>³adjusted for RACHS, age, and income;</p><p>⁴adjusted for residential status.</p><p>Relationship between risk factors and family indirect cost of congenital heart surgery.</p

Relationship between risk factors and family direct cost of congenital heart surgery.

<p>¹Adjusted for age and annual income;</p><p>²adjusted for RACHS, age, and annual income;</p><p>³adjusted for RACHS, age, and income;</p><p>⁴adjusted for residential status.</p><p>Relationship between risk factors and family direct cost of congenital heart surgery.</p

Alternate sources of finances adopted by families to meet the expenses related to child’s surgery.

<p>Alternate sources of finances adopted by families to meet the expenses related to child’s surgery.</p

Relationship between risk factors and family total cost of congenital heart surgery.

<p>¹Adjusted for age and annual income;</p><p>²adjusted for RACHS, age, and annual income;</p><p>³adjusted for RACHS, age, and income;</p><p>⁴adjusted for residential status.</p><p>Relationship between risk factors and family total cost of congenital heart surgery.</p