Darba Shahla, Safaei Naser, Mahboub-Ahari Alireza, Nosratnejad Shirin, Alizadeh Gisoo, Ameri Hosein, Yousefi Mahmood
Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Risk Manag Healthc Policy. 2020 Jul 31;13:969-978. doi: 10.2147/RMHP.S261612. eCollection 2020.
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.
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.
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.
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.
心血管疾病（CVDs）是全球主要死因。本研究旨在评估伊朗冠状动脉疾病（CAD）的直接和间接成本。
这是一项基于患病率的疾病成本（COI）研究，旨在估算CAD的直接和间接成本。研究于2017年4月至9月的六个月期间进行。患者从伊朗大不里士的马达尼医院招募。从社会角度对总共379名患者进行了调查。直接成本采用自下而上的成本核算方法估算，间接成本采用人力资本（HC）方法估算。使用广义线性回归模型探讨总成本与社会人口统计学变量之间的关系。将年度总平均成本与以购买力平价（PPP）指数形式报告的人均国内生产总值（GDP）进行比较。为应对不确定性，进行了单向敏感性分析。
每位患者一年的总成本估计为63452290.17伊朗里亚尔（7736.19美元PPP），95%置信区间为（58191511.73 - 68713068.60），其中最大部分与直接医疗成本相关，每年为33884019.53伊朗里亚尔（4131.18美元PPP）（54%）。直接非医疗成本估计为每位患者1655936.68伊朗里亚尔（201.89美元PPP）（2%），间接成本估计为每位患者27912333.97伊朗里亚尔（3403.11美元PPP）（44%），其中62%的间接成本与患者旷工有关。
本研究估算了与CAD相关的直接（56%）和间接（44%）成本。该研究探讨了成本的主要驱动因素，并以GDP份额的形式提供了负担程度。研究结果可用于确定优先事项，特别是成本效益分析，以及制定有关保险覆盖范围和公平问题的新政策。
