Cost of Hospitalization for Acute Coronary Syndrome in the Philippines

Abstract

INTRODUCTION: Acute coronary syndrome (ACS), specifically myocardial infarction, accounted  for approximately 41% of deaths due to coronary artery disease in 2013. A large number of  Filipinos are affected by ACS; thus, it is important to determine its hospitalization cost. The  study objectives were to (1) define the hospital care pathways for ACS; (2) determine the  resources used; (3) estimate the hospitalization cost for uncomplicated ACS; and (4) determine  the difference between the estimated hospitalization cost and the coverage provided by the  Philippine Health Insurance Corporation (Philhealth).  METHODS: A cost analysis study was done. Mixed qualitative and quantitative data collection  tools consisted of consultations with local cardiologists, key informant interviews, and self administered survey forms. Sensitivity analysis was performed through scenario analysis.  RESULTS: The ACS hospital care pathway was derived after consultative meetings with invasive  and noninvasive cardiologists. Using this pathway, the resources used for ACS hospitalization  were identified, and the total hospitalization costs were calculated. For medical treatment alone,  the costs were approximately Philippine peso (₱) 67,000 to ₱90,000, whereas for medical  treatment with percutaneous coronary intervention (PCI), the costs were approximately ₱265,000  to ₱425,500. In comparison, Philhealth’s maximum coverage for ACS with PCI is ₱39,750.  CONCLUSION: There is variation in the ACS hospitalization cost, depending on the  management strategy used and the type of hospital where a patient is confined. Medical plus  reperfusion with PCI increases the cost four to five times when compared with medical treatment  alone. Huge out-of-pocket expense is demonstrated because of the large discrepancy between  the actual hospitalization costs to Philhealth’s ACS coverage.  KEYWORDS: acute coronary syndrome, cost analysis, Philhealth