Catastrophic Health Expenditure and Out-of-pocket Payments for Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG)

Background: When households have high out-of-pocket (OOP) expenses, they are more likely to experience poverty and encounter catastrophic health expenditures (CHE). Heart disease is a significant cause of health decline and mortality. Objectives: This study aimed to provide essential knowledge about CHE and OOP for heart disease patients who underwent coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in Shiraz, Iran. Methods: This cross-sectional study with two prospective follow-ups was conducted in three heart surgery centers in Shiraz, Iran. The data were collected using the world health survey (WHS). Catastrophic health expenditures and OOP were asked from the most informed family member. Generalized estimating equation (GEE) modeling was employed to identify the main factors related to CHE and OOP. Binary distribution with logit link and gamma distribution with log link were used for CHE and OOP, respectively. The significance level was set at 0.05. Results: We found that OOP payment among patients who needed cardiovascular services in public-private partnership (PPP) hospitals was 76,953,100 Rials (R), equal to 2,506.78 $ (USD) (SD = 53,247,600 R/1,734.56 $) in the PCI group and 230,937,700 R equal to 7,522.89 $ (SD = 248,295,200 R/8,088.32 $) in the CABG group. This value in public hospitals was 15,083,800 R, equal to 491.36 $ (SD = 18,637,600 R/ 607.13 $) in the PCI group and 12,276,800 R, equal to 399.92 $ (SD = 11,131,900 R/ 362.63 $) in the CABG group. We also found that admission duration, age, type of hospital, and being currently a smoker were significant factors for OOP (P-value < 0.05). During baseline assessment, we also found that the percentage of PCI patients that faced CHE was 95.56% and 47.92% in PPP and public hospitals, respectively. This value in CABG patients was 92.31% and 40.45%. Our study showed that the type of hospital and socioeconomic status were significant factors (P-value < 0.05) that pushed a family facing CHE. Conclusions: The baseline CHE is very high in both PCI and CABG patients. Thus, the government should pay special attention to this issue. Further investigations are needed on factors affecting OOP and CHE.