Journal of Education and Health Promotion

The use and the cost of outpatient diagnostic procedures for cardiovascular diseases in Isfahan province: A utilization study

Document Type : Original Article

Authors

. Reza Rezayatmand
. Ghasem Yadegarfar 1
. Masoumeh Ghasemirad 2
. Farzaneh Mohammadi

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

Cardiovascular diseases
cost
outpatient
utilization study
1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, 
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.
Journal of Education and Health Promotion
Volume 12, Issue 6
July 2022
Pages 1-7

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