Abstract
BackgroundRheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa. Lack of adequate evidence regarding the cost of RHD care has hindered national and international actions to prevent RHD related deaths. The objective of this study was to estimate the cost of RHD-related health services in a tertiary hospital in the Western Cape, South Africa.MethodsThe primary data on service utilisation were collected from a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study) - a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from the main tertiary hospital providing RHD care. All annual costs from a health system perspective were estimated in 2017 (base year) in South African Rand (ZAR) using a combination of ingredients and step-down costing approaches and later converted to United States dollars (USD). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. A 3% discount rate was also employed in order to allow depreciation and opportunity cost. We aggregated data to estimate the total annual costs and the average annual per-patient cost of RHD and conducted a one-way sensitivity analysis.ResultsThe estimated total cost of RHD care at the tertiary hospital was USD 2 million (in 2017 USD) for the year 2017, with surgery costs accounting for 65%. Per-patient, average annual costs were USD 3900. For the subset of costs estimated using the ingredients approach, outpatient medications, and consumables related to cardiac catheterisation and heart valve surgery were the main cost drivers.ConclusionsRHD-related healthcare consumes significant tertiary hospital resources in South Africa, with annual per-patient costs higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programmes at primary health centers in order to reduce future tertiary care costs. The study could also inform resource allocation efforts and provide cost estimates for future studies of intervention cost-effectiveness.
Highlights
Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa
We look at outpatient costs and inpatient costs at four different levels of care – outpatient care, cardiac intensive unit (ICU) care, cardiac catheterisation laboratory, and cardiac surgical theatre care – that are the major clinical areas/levels where individuals with RHD receive cardiac services in the South African context
We focused on estimating (a) the total costs incurred at Groote Schuur Hospital (GSH) in 2017 because of RHD and (b) the per-patient annual cost of care using a representative sample of individuals requiring tertiary care at GSH
Summary
Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa. The objective of this study was to estimate the cost of RHDrelated health services in a tertiary hospital in the Western Cape, South Africa. In South Africa, private and public health systems exist in parallel. The public health system services over 80% of the population [1]. The country’s public health sector continues to face many challenges - ranging from a shortage of resources to a growing and ageing population and the high burden of diseases [1,2,3]. Non-communicable diseases (NCDs) have become a public health issue requiring urgent attention. One preventable and treatable but neglected form of NCD is rheumatic heart disease (RHD) [4]
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