Ejigu Yayehyirad, Mlambo Vongai C, Neil Kara L, Lin Yihan, Sendegeya Augustin, Umuhoza Stella M, Murengezi Josue, Ntihabose Corneille
King Faisal Hospital Rwanda, Kigali, Rwanda.
Stanford University School of Medicine, Palo Alto, California, United States of America.
PLOS Glob Public Health. 2025 Jul 30;5(7):e0004462. doi: 10.1371/journal.pgph.0004462. eCollection 2025.
Cost transparency is important to facilitate national health infrastructure planning for pediatric cardiac surgery in low-resourced settings. The aim of this paper is to determine direct medical costs of common pediatric congenital heart procedures performed by an in-house cardiac surgery program in Rwanda. Billing information for patients with isolated congenital heart disease who underwent surgery between October 2022 and April 2024 was collected from the hospital management system. Charges were organized into 10 categories, including procedure cost, theater medications and consumables, intensive care unit and ward expenses, anesthesia fees, hospital charges, room charges, testing, and ancillary services. Linear regression was performed to identify perioperative factors associated with increased costs. Costs were converted from Rwandan Francs to US Dollars using the exchange rate 1 USD = 1,262 RWF on 1 January 2024. 117 patients received 8 types of surgeries. Median costs ranged from USD$1,969.04 for patent ductus arteriosus ligation to USD$18,239.00 for arterial switch operation. Excluding the latter, the cost of surgeries was USD$7,662 or less. Theater medications and consumables were the most expensive category accounting for 44.6% (USD$3,071.28) of total costs. This was followed by the cost of cardiothoracic procedure itself which constituted 15.4% (USD$810.90) of total costs. Prolonged hospital stays and operative times increased costs by USD$172.57 and USD$1,015.35 (p < 0.001), respectively. Complications and lesion complexity did not independently predict increased costs (p > 0.05). Direct medical costs of pediatric congenital heart surgeries in Rwanda are generally lower than the mean USD$7,366 plus travel expenses charged abroad. Costs can be lowered by reducing per unit costs of theater consumables and ensuring timely discharge.
成本透明度对于促进资源匮乏地区小儿心脏手术的国家卫生基础设施规划至关重要。本文旨在确定卢旺达一家内部心脏手术项目开展的常见小儿先天性心脏手术的直接医疗成本。从医院管理系统收集了2022年10月至2024年4月期间接受手术的孤立性先天性心脏病患者的计费信息。费用分为10类，包括手术成本、手术室用药和耗材、重症监护病房和病房费用、麻醉费用、医院收费、病房收费、检查以及辅助服务。进行线性回归以确定与成本增加相关的围手术期因素。使用2024年1月1日1美元 = 1262卢旺达法郎的汇率将成本从卢旺达法郎换算为美元。117名患者接受了8种手术。中位数成本从动脉导管未闭结扎术的1969.04美元到动脉调转术的18239.00美元不等。排除后者，手术成本为7662美元或更低。手术室用药和耗材是最昂贵的类别，占总成本的44.6%（3071.28美元）。其次是心胸手术本身的成本，占总成本的15.4%（810.90美元）。住院时间延长和手术时间延长分别使成本增加172.57美元和1015.35美元（p < 0.001）。并发症和病变复杂性并不能独立预测成本增加（p > 0.05）。卢旺达小儿先天性心脏手术的直接医疗成本通常低于国外平均7366美元加上差旅费。可通过降低手术室耗材的单位成本并确保及时出院来降低成本。
