The Cost of an Elective Coronary Angiogram at the National Hospital of Sri Lanka

Abstract

Introduction: Coronary angiograms are expensive invasive cardiac imaging performed to diagnose coronary artery diseases. It was emphasized to optimize the spending on care services at government hospitals to sustain free healthcare services in Sri Lanka. Optimization of services cannot be achieved without understanding the present through detailed cost analysis. The NHSL has no mechanism to measure the cost incurred for coronary angiograms. Objectives: The study's objective was to estimate the per-procedural cost of diagnostic angiograms at the Cardiac Interventional Unit I (CIU I) of NHSL and compare that with the private sector tariffs. Method: It was a single-setting bottom-up micro-costing study combined with a top-down approach conducted at NHSL. The costs of medical consumables, pre-procedural investigations, premedication, and hospital stay were considered to be direct costs, and the rest of the expenses including human resources were indirect costs. Results: The per-procedural direct cost for diagnostic angiograms at CIU I of NHSL was SLR.32719. The indirect cost per procedure was estimated to be SLR.8490. Conclusion: The per-procedural cost of diagnostic coronary angiograms at CIU I of NHSL was estimated to be SLR.41209, contributed 79.4% by direct costs and 20.6% by indirect costs. The tariff of the leading private hospital network was found to be much higher (113.3%) than the per-procedural cost at NHSL. Recommendation: Considering the unchanged nature of direct costs within a provided health technology and fiscal environment, effective utilization of resources like operating time and manpower could minimize indirect costs and the overall per-procedural cost of diagnostic coronary angiograms.