Document Type : Original Article
Authors
1 Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran and School of Medicine, University of Central Lancashire, Preston, United Kingdom
2 Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Cardiovascular diseases (CVDs) are among the most important causes of premature
death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview
of service utilization can help policymakers to plan more effective use of those services and to cut
costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient
diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017.
MATERIALS AND METHODS: This descriptive study used insurance claim data (time period:
2011–2017) from Health Insurance Organization in Isfahan province to determine the amount of
use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these
data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for
the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was
carefully chosen according to experts’ opinions.
RESULTS: The use and the cost of outpatient diagnostic procedures for CVDs have drastically
increased in the study period (2011–2017). Since 2011, the number of procedures and their related
costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor),
respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017.
Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365
IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and
electrocardiography, respectively. A notable increase has been observed in the share of radionuclide
myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost.
CONCLUSIONS: The use of outpatient diagnostic procedures for CVDs has drastically increased
during the studied period. Consequently, the cost borne by the health system and the patients have
notably increased. This may be because of the increase in the incidence and prevalence of CVDs
during the study period. Greater access to related health services can be mentioned as another reason
for this increase. Further research is needed to explain all potential reasons and their importance,
which can provoke a suitable health policy reaction.
Keywords
Baddour LM, et al. Global burden of cardiovascular diseases and
risk factors, 1990‑2019: Update from the GBD 2019 Study. J Am
Coll Cardiol 2020;76:2982‑3021.
2. World Health Organization. (2018). Noncommunicable diseases
country profiles 2018. World Health Organization. https://apps.
who.int/iris/handle/10665/274512. License: CC BY-NC-SA 3.0 IGO.
3. Ferdosi M, Sefiddashti FM, Aghdak P, Moradi R, Mofid M,
Rejalian F, et al. Death portrait of Isfahan province in years
2007‑2011. Int J Prev Med 2016;7:96.
4. Zegre‑Hemsey J, Sommargren C, Drew B. Initial ECG acquisition
within 10 minutes of arrival at the emergency department in
persons with chest pain: Time and gender differences. J Emerg
Nurs 2011;37:109‑12.
5. Esmaeilzadeh M, Parsaee M, Maleki M. The role of
echocardiography in coronary artery disease and acute
myocardial infarction. J Tehran Heart Cent 2013;8:1‑13.
6. Vaidya GN. Application of exercise ECG stress test in the
current high cost modern‑era healthcare system. Indian Heart J
2017;69:551‑55.
7. Secretariat MA. Non‑invasive cardiac imaging technologies
for the diagnosis of coronary artery disease: A summary of
evidence‑based analyses. Ont Health Technol Assess Ser
2010;10:1‑40.
8. Lucas FL, DeLorenzo MA, Siewers AE, Wennberg DE. Temporal
trends in the utilization of diagnostic testing and treatments for
cardiovascular disease in the United States, 1993‑2001. Circulation
2006;113:374‑9.
9. Hertz JT, Fu T, Vissoci JR, Rocha TAH, Carvalho E, Flanagan B,
et al. The distribution of cardiac diagnostic testing for acute
coronary syndrome in the Brazilian healthcare system: A national
geospatial evaluation of health access. PLoS One 2019;14:e0210502.
10. Pearlman AS, Ryan T, Picard MH, Douglas PS. Evolving trends in
the use of echocardiography: A study of Medicare beneficiaries.
J Am Coll Cardiol 2007;49:2283‑91.
11. Virnig BA, Shippee ND, O'Donnell B, Zeglin J, Parashuram S.
Trends in the use of echocardiography, 2007 to 2011: Data Points
#20. 2014 May 13. In: Data Points Publication Series [Internet].
Rockville (MD): Agency for Healthcare Research and Quality
(US); 2011–. PMID: 24967475.
12. Kini V, Viragh T, Magid D, Masoudi FA, Moghtaderi A, Black B.
Trends in high‑ and low‑value cardiovascular diagnostic testing
in fee‑for‑service medicare, 2000‑2016. JAMA Netw Open
2019;2:e1913070.
13. Romiti S, Vinciguerra M, Saade W, Anso Cortajarena I, Greco E.
Artificial intelligence (AI) and cardiovascular diseases: An
unexpected alliance. Cardiol Res Pract 2020;2020:4972346.
14. Ma LY, Chen WW, Gao RL, Liu LS, Zhu ML, Wang YJ, et al.
China cardiovascular diseases report 2018: An updated summary.
J Geriatr Cardiol 2020;17:1‑8.
15. Siqueira AD, Siqueira‑Filho AG, Land MG. Analysis of the
economic impact of cardiovascular diseases in the last five years
in Brazil. Arq Bras Cardiol 2017;109:39‑46.
16. Toth PP, Danese M, Villa G, Qian Y, Beaubrun A, Lira A, et al.
Estimated burden of cardiovascular disease and value‑based
price range for evolocumab in a high‑risk, secondary‑prevention
population in the US payer context. J Med Econ 2017;20:555‑64.
17. Tarride JE, Lim M, DesMeules M, Luo W, Burke N, O’Reilly D,
et al. A review of the cost of cardiovascular disease. Can J Cardiol
2009;25:e195‑202.
18. Alipour V, Zandian H, Yazdi‑Feyzabadi V, Avesta L,
Moghadam TZ. Economic burden of cardiovascular diseases
before and after Iran’s health transformation plan: Evidence from
a referral hospital of Iran. Cost Eff Resour Alloc 2021;19:1.
19. Available from: https://data.worldbank.org/indicator/PA.NUS.
PRVT.PP?locations=IR&most_recent_value_desc=true.
)