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

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$99.7million (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.