Cost of Heart Failure In-Patient in Saudi Arabia: Role of Heart Failure Multidisciplinary Program

Abstract

Background: Globally, the prevalence of heart failure (HF) is rising in many countries, same as in Saudi Arabia but the economic burden of direct and indirect costs for HF hospitalization and re-hospitalization are not well studied in Saudi Arabia. The aim of this study was to assess the efficiency of the newly established multidisciplinary HF team at King Saud University Medical City (KSUMC) in reducing the costs of each HF patient per year. Material & Methods: A non-interventional retrospective prevalence-based single-center King Fahad Cardiac Centre (KFCC) study was conducted with all the HF in-patients from January 2014 to December 2019 at KSUMC. Results: The study included a total of 943 patients, where 531 were male, a study period of 6 years. The mean age was 61.65 ± 1.9 year, the median length of stay (LOS) was 11.6 days (compared to the global average which is 4-5 days), BMI was 29.9, the median NT-proBNP was 6015.3 pg/ml and NYHA was 2.9. Hypertension (HTN), Diabetes (DM), dyslipidemia and coronary artery disease (CAD) were the most commonly reported comorbidities in the study period. As per the recent study for Middle East (ME) countries (Egypt, Saudi Arabia and UAE), the average cost per year per patient was 8137 $. The patient’s admission and readmission cost, which were the direct costs, was the major cost driver ranging from 25% to 56% of total cost, therefore, the average admission cost was 30% of total cost. Hence the admission cost for each patient per year was 8137 $ x 30% = 2441 $. The readmission cost in 2014 was $ 90317 and in 2015 was $ 19528, which was represented a drop of 78.4%. In 2016, it was $ 17087 showing a drop of 81%. In 2017, it was 86.5% and 83.9% respectively in 2018 and 2019. The indirect medical costs were estimated based on a human capital approach. Conclusions: Our HF program has a role to keep up the positive outcomes by reducing the HF readmission, hence reduce the direct and indirect costs. We were able to reduce the re-hospitalization for NYHA Class-2 by managing in outpatient clinics and therefore reducing the total cost of HF per year. We can improve the research quality by adding higher numbers of patients with more geographical representation and estimation of other costs, such as indirect costs may be needed in future studies.