Budget Impact Analysis of the Proposed PhilHealth Case Rates for Acute Coronary Syndrome in the Philippines

Abstract

OBJECTIVE: This study aimed to determine the budget impact of the proposed revised PhilHealth case rate packages for acute coronary syndrome (ACS). METHODS: This budget impact analysis used the static approach or cost calculator modeling method. The prevalence of hospitalization for coronary artery disease in all PhilHealth-accredited hospitals in the country in 2017 and the data from the ACS registry project of the Philippine Heart Association were used in this study. The study multiplied the present PhilHealth coverage with the number of ACS hospitalization claims to come up with the total cost of ACS hospitalization in the next three years with the assumptions that the eligible population and the ACS PhilHealth case rates will remain constant for these years. The future ACS hospitalization costs were also determined if the proposed case rates were used rather than the current PhilHealth case rates. The cost of re-admissions was considered as savings in hospitalization cost (due to prevention of admissions if the appropriate interventions were given) and were deducted from the future total cost of ACS hospitalizations. RESULTS: The annual total ACS hospitalization cost using the current case rates was Php 1,134,683,000. Using the proposed case rates, the total hospitalization costs over five years was Php 2,653,019,000 in the first year (proposed case rates implemented to only 20% of the ACS patients) and increased to Php 8,726,364,000 by year 5 (full implementation of the proposed case rates or to 100% of ACS patients). This resulted in a lower incremental cost in the first year of implementation compared with a less gradual implementation over 3 years. The total incremental costs would amount to PHP7.6 billion for full implementation. CONCLUSION: The study provided the budget impact of the proposed revised ACS case rates. The incremental cost is relatively huge, however the benefits of providing coverage of guideline directed therapy including invasive strategies for ACS must be considered.