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Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-lead portable ECG devices across all primary health centers (PHC) in the district to screen cardiac abnormalities among high-risk and symptomatic adults for providing primary management and proper timely referral. The prime purpose of the study was to assess the cost-effectiveness of portable ECG for the screening of cardiovascular diseases (CVD) among high-risk and symptomatic adults at the PHC in Ahmedabad, Gujarat.Methods: Cost-effective analysis was conducted using a societal perspective. An incremental costing approach was adapted, and cost-effectiveness analysis was done using a decision-analytic model. We surveyed 73 patients who screened positive for cardiac abnormality, documented the type of ECG abnormalities, and diagnosed CVD. The program cost was obtained from the implementers. Transition probabilities were derived from primary data supported by expert opinion for the intervention arm, while a systematic search of the literature was undertaken to derive transition probabilities for the control arm.Results: The ECG screening at PHC saves 2.90 life years at an incremental cost of 89.97 USD (6657.47 INR), yielding a cost-effectiveness ratio of 31.07 USD (2,299.06 INR) per life-year saved, which is below the willingness to pay threshold. The budget impact analysis was also performed. Results are sensitive to the relative risk reduction associated with the non-participation and the cost of initial screening.Conclusion: Cost-effectiveness analysis clearly shows that the facility to screen cardiac abnormality at the PHC level is highly recommended for high-risk adults and symptomatic cases.

Background: COVID-19 has financially burdened Government’s healthcare system as well as households with COVID-19 patients. Present study aims to value the out-of-pocket expenditure and health-related quality of life (HRQOL) using EQ-5D-5L among COVID-19 patients who sought treatment in COVID-19 center of a tertiary hospital in Vadodara, Gujarat. Methods: The present analysis is a prospective real-world study. The questionnaire included socio-demographic data, health status, out-of-pocket expenses associated with treatment of COVID-19, and EQ-5D-5L scale. The relationships of all factors and the scores of EQ-5D-5L were analyzed. All costs are reported in Indian Rupees and then converted to US dollars. Result: Out of total 138 participants included in the study, 108 (78.3%) participants had mild to moderate symptoms of COVID-19 infection and were admitted to COVID Care Centre (CCC) while 30 (21.7%) patients had severe disease and were admitted to COVID Intensive Care Unit (ICU). Mean total out of pocket expenditure for the patient admitted to COVID CCC and COVID ICU was INR 11,333.07 (31,707.68) and 27,374.17 (54,205.72) respectively. The respondents obtained a mean EQ-5D-5L index score of 0.755 (±0.180) for patients under COVID CCC and 0.513 (±0.378) for COVID ICU admitted patients. EQ-VAS index was 75.05 (±12.12) and 62 (±16.37) respectively, signifying the HRQoL from patient’s perspective. Conclusion: COVID-19 patients have suffered from significant physical and psychological impairment. It is essential to prospectively monitor the individuals who suffered from COVID-19 to understand the long term impact on HRQoL, as well as to inform prompt and efficient interventions to alleviate suffering.