Inpatient costs of congenital heart surgery in China: results from the National Centre for Cardiovascular Diseases

Background Economic data on congenital heart disease (CHD) in China are scarce. Therefore, this study aimed to explore the inpatient costs of congenital heart surgery and related healthcare policies from a hospital perspective.Method We used data from the Chinese Database for Congenital Heart Surgery (CDCHS) to prospectively analyse the inpatient costs of congenital heart surgery from May 2018 to December 2020. The total expenditure was divided into 11 columns (medications, imaging, consumable items, surgery, medical cares, laboratory tests, therapy, examina-tions, medical services, accommodations, and others), and explored according to the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, year, different age group, and CHD complexity. Authority economic data (index for gross domestic product [GDP], GDP per capita, per capita disposable income and average annual exchange rate of 2020 Chinese Yuan against US dollar) were accessed via the National Bureau of Statistics of China to better describe the burden. In addition, potential factors contributing to the costs were also investigated by using generalised linear model.Findings All values are presented in 2020 Chinese Yuan ( yen ). A total of 6568 hospitalisations were enrolled. The median of overall total expenditure was yen 64,900 ( 9409 US Dollar [USD], interquartile range [IQR]: yen 35,819), with the lowest in STAT 1 ( yen 57,014 8266 USD, [IQR]: yen 16,774) and the highest in STAT 5 ( yen 194,862 28,251 USD, [IQR]: yen 130,010). The median costs during the 2018 to 2020 period were yen 62,014 ( 8991 USD, [IQR]: yen 32,628), yen 64,846 ( 9401 USD, [IQR]: yen 34,469) and yen 67,867 ( 9839 USD, [IQR]: yen 41,496). Regarding to age, the median costs were highest in the <= 1 month group ( yen 144,380 20,932 USD, [IQR]: yen 92,584). Age, STAT category, emergency, genetic syndrome, delay sternal closure, mechanical ventilation time, and complications were significantly contributed to the inpatient costs.Interpretation For the first time, the inpatient costs of congenital heart surgery in China are delineated in detail. According to the results, CHD treatment has achieved significant progress in China, but it still causes substantial economic burden to both families and society. In addition, ascending trend of the inpatient costs was observed during the period of 2018-2020, and the neonatal was revealed to be the most challenging group.Funding This study was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS,2020-I2M-C&T-A-009), Capital Health Research and Development of Special Fund (2022-1-4032), and The City University of Hong Kong New Research Initiatives/Infrastructure Support from Central (APRC, 9610589).Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This study explores the inpatient costs of congenital heart surgery in China and reveals the significant economic burden it imposes on families and society. It also identifies an upward trend in costs from 2018 to 2020 and highlights the neonatal group as the most challenging.