Catastrophic health expenditure for acute heart failure hospitalisation in sub-Saharan Africa
A C Mbakwem, C E Amadi, J I Obieli, B FagboyindeAbstract
Background
The major healthcare expenditure for the management of heart failure comes from hospitalization costs. This economic burden is worse in systems with out-of-pocket payment for health care and this usually leads to catastrophic healthcare expenditure for the individual defined by WHO as healthcare expenditure amounting to more than 10% of the household income. This mitigates against achievement of the Sustainable Development Goal 3.8.2, an indicator to track a country’s progress toward universal health coverage (UHC) on the financial protection against catastrophic health expenditure (CHE).
Purpose
We investigated the cost of hospitalization at an academic hospital in West Africa and its economic burden on the patients and the alignment with SDG 3.8.2
Methods
All consenting patients who were admitted for management of acutely decompensated HF were recruited. Their sociodemographic, clinical, and echocardiographic data were entered into a CRF. Cost of board, investigations and medications were collated at discharge and length of stay calculated. Data was analysed using SPSS 26 and presented as means, medians and counts. Relationship between underlying disease, precipitants, LOS was interrogated. Frequency of catastrophic health expenditure and its relation to selected parameters was also interrogated.
Results
165 consenting patients hospitalized for acute heart failure were recruited. The mean age was 53.8±16.3 and 89 (53.9%) were males. About 91 (63.7%) were low wage earners (artisans, traders, drivers and junior civil servants etc). The commonest HF aetiology was hypertensive heart disease 50(42.7%), 67 (52.3%) and 48 (37.5%) were in NYHA class III and IV respectively. Median EF was 38% (30%-50%); 57.2%, 17.2% and 25% had HFrEF, HFmrEF, and HFpEF respectively. The median LOS was 10days (7-16). The median income for the participant was $69.0 ($20.7-241.4) and 47.5% were earning minimum wage salary $48.3 or less. The median total cost of hospitalization was $111.1 ($76.8-195.4) excluding intangible costs and lost earnings. This represents 1.6 times the median income and 2.3 times the minimum wage.
Conclusions
Acute heat failure hospitalisation cost constitutes catastrophic health expenditure in West Africa as low most low-income earners are spending more than one and half times their income on hospitalization bills for HF. There is an urgent need to operationalize UHC in these low resource settings.For image description, please refer to the figure legend and surrounding text.