Alipour Vahid, Zandian Hamed, Yazdi-Feyzabadi Vahid, Avesta Leili, Moghadam Telma Zahirian
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
Cost Eff Resour Alloc. 2021 Jan 3;19(1):1. doi: 10.1186/s12962-020-00250-8.
Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP.
This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran's Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR).
Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients' OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively.
Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region.
不同国家制定了不同政策来控制和降低心血管疾病（CVDs）的成本。伊朗近期通过一项名为健康转型计划（HTP）的改革，旨在减轻不同疾病的经济负担。本研究旨在考察HTP实施前后CVDs的经济负担。
本横断面研究对600例CVDs患者进行，这些患者是从伊朗西北部一家专业心血管医院随机选取的。使用疾病成本法和人力资本法计算CVDs的直接和间接成本。数据收集采用研究者自制的清单，该清单来自多个来源，包括结构化访谈、伊朗统计中心、伊朗合作社、劳工和社会福利部、伊朗中央银行，以及从健康指标与评估研究所获取的全球疾病负担数据，以估算直接成本和死亡成本。所有成本均以伊朗里亚尔（IRR）计算。
HTP实施前后，CVDs的总成本分别约为55710亿里亚尔和67000亿里亚尔。CVDs总成本的62%以上在HTP实施前（64.89%）和实施后（62.01%）是由过早死亡造成的。HTP实施后，CVDs的总住院成本显著增加（p = 0.038）。在两个时期，手术服务和门诊在住院成本中所占份额分别最高和最低。自付费用显著下降，从54.2%降至36.7%。除患者自付费用外，HTP实施后所有住院成本显著增加约1.3倍。直接非医疗成本在HTP实施前后分别从24亿里亚尔增至33亿里亚尔。
HTP实施后，伊朗西北部CVDs的经济负担增加，原因是除自付费用外，所有直接和间接成本均增加。既定资源未得到分配，这与伊朗面临的国际和国内政治经济挑战相契合，导致HTP资源不可持续。因此，本研究的结果不能完全归因于HTP。所以，应针对该地区CVDs成本显著增加的原因开展更详细的研究。
