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Canadian Journal of Cardiology

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

Published:February 10, 2017DOI:https://doi.org/10.1016/j.cjca.2017.01.024

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Résumé

      Introduction

      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.

      Méthodes

      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.

      Résultats

      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.

      Conclusions

      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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