Direct and Indirect Costs Associated with Coronary Artery (Heart) Disease in Tabriz, Iran

Abstract

Purpose

Cardiovascular diseases (CVDs) are the major causes of mortalities worldwide. This study was conducted to evaluate the direct and indirect costs of coronary artery disease (CAD) in Iran.

Patients and Methods

This is a prevalence-based cost-of-illness (COI) study that estimates the direct and indirect costs of CAD. The study conducted over a six-month period from April to September in 2017. Patients were recruited from Madani hospital in Tabriz, Iran. A total of 379 patients were investigated from societal perspective. Direct costs were estimated using the bottom-up costing approach and indirect costs were estimated using the Human Capital (HC) approach. A generalized linear model of regression was used to explore the relation between total cost and socio-demographic variables. The total annual mean cost was compared to Gross Domestic Product (GDP) per capita which was reported in the form of Purchasing Power Parity (PPP) index. To deal with uncertainty, one-way sensitivity analysis was performed.

Results

Total costs per patient in one year were estimated to be IRR 63452290.17 ($PPP 7736.19) at a 95% confidence interval (58191511.73–68713068.60), the biggest part of which is related to direct medical costs with IRR 33884019.53 per year ($PPP 4131.18) (54%). Direct non-medical costs were estimated IRR 1655936.68 ($PPP 201.89) per patient (2%) and indirect costs were estimated IRR 27912333.97 per patient ($PPP 3403.11) (44%), which 62% of indirect costs is related to patients’ work absenteeism.

Conclusion

This study estimates the direct (56%) and indirect (44%) costs associated with CAD. The study explores the essential drivers of the costs and provides the magnitude of the burden in terms of the share of GDP. The outcomes can be used in priority setting, in particular for cost benefit analysis, and adopting new policies regarding insurance coverage and equity issues.

Keywords:

• coronary heart disease (CHD)
• direct cost
• indirect cost
• cost-disease analysis

Acknowledgments

We are most grateful and extend our sincere thanks to all people who participated in this study. This paper has been extracted from part of ShD's master thesis, supervised by MY and supported by Tabriz University of Medical Sciences (approval ID: IR.TBZMED.REC.1396.137).

Abbreviations

CVD, Cardiovascular diseases; COI, Cost-of-illness; GDP, Gross Domestic Product; NCDs, Non-communicable Diseases; CHD, Coronary heart disease; PPP, Purchasing Power Parity; CAD, Coronary artery disease; ECG, Electrocardiogram.

Disclosure

The authors report no conflicts of interest in this work.