Financial burden of heart failure in a developing country: cost analysis from Manipal Heart Failure Registry, India

Aim: To estimate the comprehensive healthcare costs of heart failure (HF) and determine the utilization of healthcare resources (HRU) for 2 years following index hospitalization. Subjects and methods: The Manipal Heart Failure Registry (MHFR) is a prospective registry analyzing the financial burden and HRU in 610 patients with HF. Costs incurred by patients during 2 years following index hospitalization were estimated, and their association with socio-demographic and clinical factors were calculated. After 54 (8.8%) in-hospital mortalities, 556 patients were followed up for 2 years. Results: The mean age of the study cohort was 65.08 ± 13.6 years, and 245 (40.2%) were females. Based on the ejection fraction (EF), 506 (82.9%) patients were diagnosed as having HF with reduced EF. Average hospital stay during index admission was 5.3 ± 2.9 days. Total expenditure during index hospitalization was INR 36.3 million and during 2-year follow-up was INR 45.2 million. Average total expenditure per patient was INR 133,663. The average out-of-pocket expense was INR 82,766 and average health insurance coverage was INR 50,896. Difference in expenditure was significant (P < 0.05) between specific groups, i.e., etiologies, genders, HF phenotypes, age groups, and healthcare insurance types. Conclusion: Healthcare expenditure of patients with HF in India is much lower than for the western counterparts. Higher utilization of healthcare resources in HF patients with ischemic etiology, non-compliant to medications, and elderly (age > 60 years) was associated with increased expenses. Interventional procedures and implantations account for the bulk of the expenses in ischemic HF patients. Trial registration number: Clinical Trial Registry of India: CTRI/2017/11/010395; National Institute of Health (NIH) clinical trial no.: NCT03157219.