Comparative Study on Cost Analysis of Interventional Cardio Thoracic services in Sri Lanka- 2016 K. M. Sriyani Padmalatha( RN, RM) ( BSc (Nursing) , EMSc ( health Admin). Visiting lecture( IIHS) Cardiothoracic Operating Theater The National Hospital of Sri Lanka Colombo, Sri Lanka

Introduction Sri Lanka provides free universal healthcare, from the state sector Escalating of healthcare Cost is the biggest issue facing most countries in 2015 The ageing population and rise in non communicable diseases (NCDs) will increase the burden on the healthcare system The government spends Rs 3.5 Billion per year to treat heart patients Over 5,000 patients are waiting for Heart Surgery in the Government Hospital

Burden of Disease NCDs; Mortality from Cardiac Disease

Objectives General : Specific To study the Cost of Interventional Cardio Thoracic Services in Sri Lanka , 2016 Specific To study the Unit cost of Open hear surgery (CABG) in Sri Lanka , 2016 to study the unit cost of Stent and balloon therapy in Sri Lanka , 2016 To compare the government and private sector Cardiac interventional cost, 2016

Methods Design: Cost contributors: Descriptive, Cross sectional study with an analytical component. Comparative study on Cost Analysis of Interventional Cardio Thoracic Services in Sri Lanka. Cost contributors: Human Resource, Equipment, Space, and Supply

Methods Process Calculation Analysis the cost of Government sector interventional cost for cardiac procedure Analysis the cost of Private sector interventional cost for cardiac procedure Comparative analysis of Government, Private interventional centers with foreign cost Calculation Unit cost of CABG and stinting and balloon therapy

Results –Operation Theater Intervention -CABG Total Number of Surgeries (CABGs) per year - 336 Unit cost Rs: 948019.14 Cost contributors Annual cost ( LKR) % Human Resource 21,060,000.00 6.7% Equipment 8,724,433.33 2.7% Space 21,600,000.00 Supplies 267,150,000.00 83.8%

Results cont. – Cardiac Cath Lab Stent & Balloon Therapy Total Number of Stent & balloon therapy per year – 898 Unit cost Rs: 655509.43. Cost contributors Annual cost ( LKR) % Human resource 2,095,333.00 0.4% Equipment 37,601,643.00 6.4% Space 21,600,000.00 3.7% Supplies 527350500.00 89.6%

Cost contributors for CABG

Supply cost for CABG Supply cost ( 83.8%) Consumable (85.4%) Medical Pharmacy (14.3%) Consumable (85.4%) Non medical 0.2%

Consumables Consumable ( 85.4%) Total consumable for surgery ( 95%) Cost of the Pump 64% Other surgical consumable 36% For Anesthesia 5%

The CABG and Stent & Balloon Therapy State sector : The cost contribution of the CABG and Stent & Balloon Therapy take a similar percentages The unit cost calculated only for the OT and Catheterization Lab This cost excludes investigation, ward/ ICU , consultation and rehabilitations costs Supply cost takes up more than 80 % of both interventions Private sector : CABG total cost for = Rs. 1000,000 & Stent & Balloon Therapy Rs. 600,000 This is inclusive of Investigation and room charges This is excluding the Pump charge for CABG and Rehabilitation fees ( with the Pump charge total cost = 1,300,000)

International Cost comparison Country CABG (USD) Stent & Balloon Therapy( USD) Sri Lanka 6,849.30 4452.10 India 75,000.00 5,700.00 Singapore 22,100.00 11,850.00 USA 35,000.00 2,8200.00

Discussion The state sector unit cost for CABG cost seems to be higher than the private sector Similar costing amounts seen for Stent & Balloon therapy in both Private & Govt Sector High surgical consumable cost - more than 80 % of both interventions Sri Lanka’s cost for CABG and Stent & Balloon therapy is lower than the international market This gives the opportunity for Medical Tourism

Recommendation Routine cost analysis; Further study Medial tourism This cost exclude investigation, ward/ ICU , consultation and rehabilitations costs; needed to be analyzed with a view to calculate the total unit cost for respective interventions . Further study High surgical consumable cost needed to be investigated with view to find a cost effective solution Cost benefit analysis and Outcome analysis in both interventions Medial tourism

References Dr Kithsiri Edirisinghe(2002) cost analysis of patient care services, Ibid (2014)Total spending is for the 60 markets that EIU covers. World industry outlook: Healthcare and pharmaceuticals, Economist Intelligence Unit, Industry Report,(2014) Healthcare: United States of America, The Economist Intelligence Unit, Industry Report, (2014)Healthcare: Canada, The Economist Intelligence Unit, World industry outlook(2014): Healthcare and pharmaceuticals, The Economist Intelligence Unit, country.eiu.com/article.aspx?articleid=1502512534&Country=Sri%20Lanka... .Emerging Health Challenges in Sri Lanka: More Money for Health and More Health for the Money samamthi bandara (@011)Welcome to ‘Talking Economics’, the blog of the Institute of Policy Studies of Sri Lanka (IPS), Sri Lanka’s apex socio-economic policy think tank Report(2015 )Sri Lanka at high risk of heart diseases: See more at: http://www.dailymirror.lk/77253/sri-lanka-at-high-risk-of-heart-diseases-report#sthash.1GQ1OhNr.dpufhttp://www.dailymirror.lk/77253/sri-lanka-at-high-risk-of-heart-diseases-report more at: http://www.dailymirror.lk/77253/sri-lanka-at-high-risk-of-heart-diseases-report#sthash.1GQ1OhNr.dpuf Enas A. Enas (2015)Founder President & CEO,CADI Research Foundation1935 Green Trails Dr.Lisle, IL 60532, USA Tel: 630-961-0279 Fax: 630-961-9554 Email: cadiusa.org@gmail.com Abeywardena (2003) MY. Dietary fats, carbohydrates and vascular disease: Sri Lankan perspectives. Atherosclerosis. ;171(2):157-161. Mendis S.(1998) Coronary risk factors in the Sri Lankan population. Colombo: Ministry of Health, Sri Lanka;  Mendis S, Ekanayake EM.(1994) Prevalence of coronary heart disease and cardiovascular risk factors in middle aged males in a defined population in central Sri Lanka. Int J Cardiol. 46(2):135-142.

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