Canadian Journal of Cardiology

Cost of Congenital Heart Disease Hospitalizations in Canada: A Population-Based Study

Published:February 10, 2017DOI:



      The prevalence of congenital heart disease (CHD) is rising, and late complications are common. The impact of these factors on health-care costs is not well understood. We sought to describe inpatient CHD costs in Canada.


      We conducted an observational retrospective cohort study. The Canadian Institute for Health Information (CIHI) Discharge Abstract Database was used for all Canadian provinces, except Quebec, between April 2004 and March 2014. We included hospitalizations with a main diagnosis of CHD (International Classification of Diseases, 10th revision, codes Q20.0-26.9) and hospitalizations having CHD as a secondary diagnosis if the main diagnosis was a comorbid condition related to CHD. CIHI patient cost estimates were used to provide dollar values. Costs were inflated to 2016 Canadian dollars.


      Among 59,917 hospitalizations, annual CHD costs increased by 21.6% from CAD$99.7 million (95% confidence interval [CI], $89.4-$110.1 million) in 2004 to $121.2 million (95% CI, $112.8-$129.6 million) in 2013 (P < 0.001). Costs were higher for children compared with adults. However, the cost increase was greater in adults (4.5%/y; P < 0.001) than in children (0.7%/y; P = 0.006). Adults accounted for 38.2% of costs in 2004 vs 45.8% in 2013 (P = 0.002). Costs increased most among adults with complex CHD (7.2%/y; P = 0.001). Adult men accounted for greater increases in costs relative to women (P < 0.001). Length of stay was unchanged over time.


      Inpatient CHD costs are increasing independent of inflation, particularly among adults with complex lesions. Although children still account for greater inpatient CHD costs, a larger increase was observed among adults. These data are important in allocating inpatient resources for adults with CHD.



      La prévalence de la cardiopathie congénitale (CC) augmente, et les complications tardives sont fréquentes. On ne comprend pas bien les conséquences de ces facteurs sur les dépenses en santé. Nous avons cherché à décrire les coûts d’hospitalisation liés à la CC au Canada.


      Nous avons mené une étude de cohorte rétrospective. Nous avons utilisé la Base de données sur les congés des patients de l’Institut canadien d’information sur la santé (ICIS) pour toutes les provinces canadiennes, excepté le Québec, entre avril 2004 et mars 2014. Nous avons inclus les hospitalisations dont la raison du diagnostic principal était la CC (10e révision de la Classification internationale des maladies, codes Q20.0-26,9) et les hospitalisations dont la raison du diagnostic secondaire était la CC, mais que le principal diagnostic était un état comorbide lié à la CC. Nous avons utilisé les estimations des coûts par patient de l’ICIS pour fournir des valeurs en dollars. Les coûts ont été convertis en dollars canadiens 2016.


      Parmi les 59 917 hospitalisations, les coûts annuels liés à la CC ont augmenté de 21,6 %, soit de 99,7 M$ CA (intervalle de confiance [IC] à 95 %, 89,4 M$-110,1 M$) en 2004 à 121,2 M$ CA (IC à 95 %, 112,8 M$-129,6 M$) en 2013 (P < 0,001). Les coûts ont été plus élevés chez les enfants que chez les adultes. Cependant, l’augmentation des coûts a été plus importante chez les adultes (4,5 %/an ; P < 0,001) que chez les enfants (0,7 %/an ; P = 0,006). Les adultes ont représenté 38,2 % des coûts en 2004 vs 45,8 % en 2013 (P = 0,002). Les coûts ont augmenté davantage chez les adultes atteints d’une CC complexe (7,2 %/an ; P = 0,001). Les hommes adultes ont affiché de plus fortes augmentations de coûts que les femmes (P < 0,001). Avec le temps, la durée du séjour est demeurée inchangée.


      Les coûts d’hospitalisation liés à la CC augmentent indépendamment de l’inflation, particulièrement chez les adultes ayant des lésions complexes. Bien que les enfants représentent encore des coûts plus élevés d’hospitalisation liés à la CC, une plus forte augmentation a été observée chez les adultes. Ces données sont importantes pour l’allocation des ressources hospitalières destinées aux adultes atteints de CC.
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        • Marelli A.J.
        • Ionescu-Ittu R.
        • Mackie A.S.
        • et al.
        Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010.
        Circulation. 2014; 130: 749-756
        • Warnes C.A.
        The adult with congenital heart disease: born to be bad?.
        J Am Coll Cardiol. 2005; 46: 1-8
        • Perloff J.K.
        • Warnes C.A.
        Challenges posed by adults with repaired congenital heart disease.
        Circulation. 2001; 103: 2637-2643
        • Agarwal S.
        • Sud K.
        • Menon V.
        Nationwide hospitalization trends in adult congenital heart disease across 2003-2012.
        J Am Heart Assoc. 2016; 5: 10
        • Opotowsky A.R.
        • Siddiqi O.K.
        • Webb G.D.
        Trends in hospitalizations for adults with congenital heart disease in the U.S.
        J Am Coll Cardiol. 2009; 54: 460-467
        • Islam S.
        • Yasui Y.
        • Kaul P.
        • Marelli A.J.
        • Mackie A.S.
        Congenital heart disease hospitalizations in Canada: A 10-year experience.
        Can J Cardiol. 2016; 32: 197-203
        • Dean P.N.
        • Hillman D.G.
        • McHugh K.E.
        • Gutgesell H.P.
        Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome.
        Pediatrics. 2011; 128: e1181-e1186
        • Borisenko O.
        • Wylie G.
        • Payne J.
        • et al.
        The cost impact of short-term ventricular assist devices and extracorporeal life support systems therapies on the National Health Service in the UK.
        Interact Cardiovas Thorac Surg. 2014; 19: 41-48
        • Mahle W.T.
        • Ianucci G.
        • Vincent R.N.
        • Kanter K.R.
        Costs associated with ventricular assist device use in children.
        Ann Thorac Surg. 2008; 86: 1592-1597
        • Levy R.A.
        • Tamblyn R.
        • Fitchett D.
        • McLeod P.
        • Hanley J.A.
        Coding accuracy of hospital discharge for elderly survivors of myocardial infarction.
        Can J Cardiol. 1999; 15: 1277-1282
        • Austin P.C.
        • Daly P.A.
        • Tu J.V.
        A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario.
        Am Heart J. 2002; 144: 290-296
        • Humphries K.H.
        • Rankin J.M.
        • Carere R.G.
        • et al.
        Co-morbidity data in outcomes research: are clinical data derived from administrative databases a reliable alternative to chart review?.
        J Clin Epidemiol. 2000; 53: 343-349
        • Rawson N.S.B.
        • Malcolm E.
        Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care datafiles.
        Stat Med. 1995; 14: 2627-2643
        • Frohnert B.K.
        • Lussky R.C.
        • Alms M.A.
        • et al.
        Validity of hospital discharge data for identifying infants with cardiac defects.
        J Perinatol. 2005; 25: 737-742
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • D'Hoore W.
        • Bouckaert A.
        • Tilquin C.
        Practical considerations on the use of the Charlson comorbidity index with administrative data bases.
        J Clin Epidemiol. 1996; 49: 1429-1433
        • Warnes C.A.
        • Liberthson R.
        • Danielson G.K.
        • et al.
        Task force 1: the changing profile of congenital heart disease in adult life.
        J Am Coll Cardiol. 2001; 37: 1170-1175
        • Canadian Institute for Health Information
        Patient cost estimator.
        (Available at:) (Accessed February 26, 2015)
        • Canadian Institute for Health Information
        Cost of a standard hospital stay.
        (Available at:) (Accessed February 26, 2015)
      1. Alberta Interactive Health Data Application.
        (Available at:) (Accessed July 16, 2015)
        • Bank of Canada
        Inflation calculator.
        (Available at:) (Accessed April 30, 2016)
      2. Statistics Canada. Consumer Price Index.
        (Available at:) (Accessed April 30, 2016)
        • Manning W.G.
        • Mullahy J.
        Estimating log models: to transform or not to transform?.
        J Health Econ. 2001; 20: 461-494
        • Gurvitz M.Z.
        • Inkelas M.
        • Lee M.
        • Stout K.
        • Escarce J.
        • Chang R.K.
        Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood.
        J Am Coll Cardiol. 2007; 49: 875-882
        • Afilalo J.
        • Therrien J.
        • Pilote L.
        • et al.
        Geriatric congenital heart disease: burden of disease and predictors of mortality.
        J Am Coll Cardiol. 2011; 58: 1509-1515
        • Khairy P.
        • Ionescu-Ittu R.
        • Mackie A.S.
        • et al.
        Changing mortality in congenital heart disease.
        J Am Coll Cardiol. 2010; 56: 1149-1157
        • Pasquali S.K.
        • Jacobs M.L.
        • He X.
        • et al.
        Variation in congenital heart surgery costs across hospitals.
        Pediatrics. 2014; 133: e553-e560
        • Teng J.
        • Mayo N.E.
        • Latimer E.
        • et al.
        Costs and caregiver consequences of early supported discharge for stroke patients.
        Stroke. 2003; 34: 528-536
        • Migliaccio-Walle K.
        • Caro J.J.
        • Ishak K.J.
        • O'Brien J.A.
        Costs and medical care consequences associated with the diagnosis of peripheral arterial disease.
        Pharmacoeconomics. 2005; 23: 733-742
        • Goeree R.
        • Blackhouse G.
        • Petrovic R.
        • Salama S.
        Cost of stroke in Canada: a 1-year prospective study.
        J Med Econ. 2005; 8: 147-167
        • Tran D.T.
        • Ohinmaa A.
        • Thanh N.X.
        • et al.
        The current and future financial burden of hospital admissions for heart failure in Canada: a cost analysis.
        CMAJ Open. 2016; 4: E365-E370
        • Khairy P.
        • Fernandes S.M.
        • Mayer Jr., J.E.
        • et al.
        Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery.
        Circulation. 2008; 117: 85-92
        • Feltes T.F.
        • Cabalka A.K.
        • Meissner H.C.
        • et al.
        Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease.
        J Pediatr. 2003; 143: 532-540
        • Granbom E.
        • Fernlund E.
        • Sunnegårdh J.
        • Lundell B.
        • Naumburg E.
        Respiratory tract infection and risk of hospitalization in children with congenital heart defects during season and off-season: a Swedish national study.
        Pediatr Cardiol. 2016; 37: 1098-1105
        • Negishi J.
        • Ohuchi H.
        • Yasuda K.
        • et al.
        Unscheduled hospitalization in adults with congenital heart disease.
        Korean Circ J. 2015; 45: 59-66
        • Cedars A.M.
        • Burns S.
        • Novak E.L.
        • Amin A.P.
        Predictors of rehospitalization among adults with congenital heart disease are lesion specific.
        Circ Cardiovasc Qual Outcomes. 2016; 9: 566-575