Cost analysis of 163 consecutive heart transplant operationsin an Indian setting

Abstract

Objectives

Heart transplantation has become an established procedure in India with increasing numbers being done annually. The majority of these patients are very sick with a history of multiple hospital admissions. The economic burden of such therapy is substantial and the costs are borne by the patients with very little insurance coverage. The objective of this study was to estimate the following:

• 1. The average cost of a heart transplant procedure in a “real-world setting” in a private healthcare facility in India, with varying patient risk profiles.

• 2. Identify the factors contributing to the wide variations in cost seen in practice.

• 3. Finally, based on data thus collected, can some kind of estimation be made about the expected cost in a given patient before the operation is done?

Methods

The cost incurred by the hospital in doing 168 heart transplants during a 3-year period was analyzed. Costs were divided into direct and indirect costs. The direct costs consisted of medical consumables, laboratory investigations, radiology, costs involved in organ harvest and transport, and diet. Direct cost was 40 % of the total cost of the procedure and was used as a surrogate for total costing estimates.

Results

There was a wide variation in direct costs almost tenfold, ranging from INR 240,882 to 2403193 with a mean of 603755.The cost was affected by length of stay in the hospital, whether a patient survived or died and whether the patient died within 7 days of surgery or later. It was also affected by patient-specific factors like the INTERMACS status and preoperative creatinine levels. The average cost of the entire transplant procedure was INR 1459000.

Conclusion

There is a wide variation in the cost incurred by the hospital in doing transplants dictated to a large extent by patient risk profiles. A “One package fits all model” is unrealistic. The data pertains to the cost to the hospital and not the hospital bill and is therefore relevant to any health care facility, public or private. This study provides a framework for Governmental and private insurance agencies to fix the reimbursement rates.