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Direct and Indirect Costs Associated with Coronary Artery (Heart) Disease in Tabriz, Iran

Authors Darba S, Safaei N, Mahboub–Ahari A, Nosratnejad S, Alizadeh G, Ameri H, Yousefi M

Received 19 May 2020

Accepted for publication 14 July 2020

Published 31 July 2020 Volume 2020:13 Pages 969—978

DOI https://doi.org/10.2147/RMHP.S261612

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Marco Carotenuto


Shahla Darba,1 Naser Safaei,2 Alireza Mahboub–Ahari,3 Shirin Nosratnejad,3 Gisoo Alizadeh,4 Hosein Ameri,5 Mahmood Yousefi3

1Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; 2Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Health Economics, Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Health Policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; 5Health Policy and Management Research, Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Science, Yazd, Iran

Correspondence: Mahmood Yousefi Department of Health Economics
Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
Tel +98 912 175 5785
Fax +98 41-33251362
Email mahmoodyousefi59@gmail.com

Purpose: Cardiovascular diseases (CVDs) are the major causes of mortalities worldwide. This study was conducted to evaluate the direct and indirect costs of coronary artery disease (CAD) in Iran.
Patients and Methods: This is a prevalence-based cost-of-illness (COI) study that estimates the direct and indirect costs of CAD. The study conducted over a six-month period from April to September in 2017. Patients were recruited from Madani hospital in Tabriz, Iran. A total of 379 patients were investigated from societal perspective. Direct costs were estimated using the bottom-up costing approach and indirect costs were estimated using the Human Capital (HC) approach. A generalized linear model of regression was used to explore the relation between total cost and socio-demographic variables. The total annual mean cost was compared to Gross Domestic Product (GDP) per capita which was reported in the form of Purchasing Power Parity (PPP) index. To deal with uncertainty, one-way sensitivity analysis was performed.
Results: Total costs per patient in one year were estimated to be IRR 63452290.17 ($PPP 7736.19) at a 95% confidence interval (58191511.73– 68713068.60), the biggest part of which is related to direct medical costs with IRR 33884019.53 per year ($PPP 4131.18) (54%). Direct non-medical costs were estimated IRR 1655936.68 ($PPP 201.89) per patient (2%) and indirect costs were estimated IRR 27912333.97 per patient ($PPP 3403.11) (44%), which 62% of indirect costs is related to patients’ work absenteeism.
Conclusion: This study estimates the direct (56%) and indirect (44%) costs associated with CAD. The study explores the essential drivers of the costs and provides the magnitude of the burden in terms of the share of GDP. The outcomes can be used in priority setting, in particular for cost benefit analysis, and adopting new policies regarding insurance coverage and equity issues.

Keywords: coronary heart disease (CHD), direct cost, indirect cost, cost-disease analysis

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