Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study

Abstract

IntroductionThe increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH).MethodsThis cross-sectional study was conducted from the healthcare providers’ perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test.ResultsThe mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients’ comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost.ConclusionsThe high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia.

Economic Evaluation for Health Advocacy and Informed Policy

“…These are important to maintain an equitable basis for financing health services in the face of escalating health care cost. For the participating cardiac centers, the comparative analysis of clinical and cost management was able to show the areas of improvement that are necessary to improve efficiency of service provision (Lee, Azman, et al, 2017).…”

Estimating the economic burden of influenza on the older population in Malaysia

“…In this study, the cost data was collected from a teaching hospital in Malaysia which might not be generalised to other public and private hospitals in Malaysia. Cost of medical procedures and hospitalisation are often depending on the hospital type, management preference and outcome of procedures [32]. To our knowledge, this is the first study in Malaysia presenting the economic burden of influenza in older adults.…”

Gestão baseada em evidências: desenvolvimento de >i<framework >/i<para apoio à incorporação da gestão baseada em evidências aos processos de tomada de decisão em hospitais universitários federais

“…Estudo realizado para o tratamento de doença coronariana em hospitais gerais e hospitais universitários mostrou que nos hospitais gerais o tempo de tratamento é menor, assim como seu custo (LEE et al, 2017). A justificativa identificada pelos autores é a de que os pacientes que acessam os hospitais universitários geralmente têm um quadro de saúde mais complexo, com mais comorbidades, além do tempo de acompanhamento no processo formativo dos alunos, com uso de alta tecnologia e a abordagem de tratamento ser mais intensiva.…”