title: Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.
abstract: BACKGROUND
  The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective.
  
  
  METHODS
  Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014) in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule.
  
  
  RESULTS
  The median age was 8.2 months (IQR: 3.0- 36.0 months). Most families belonged to upper middle (43.0%) and lower middle (35.7%) socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139) [I$ 11989 (IQR: 9696-15804)], which was 0.93 (IQR: 0.52-1.49) times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50) and job-days was 15 (IQR: 11-24). Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery.
  
  
  CONCLUSIONS
  Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Manu
authors.initials: M
authors.lastname: Raj
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Paul
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Abish
authors.initials: A
authors.lastname: Sudhakar
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Anu Alphonse
authors.initials: AA
authors.lastname: Varghese
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Aareesh Chittulliparamb
authors.initials: AC
authors.lastname: Haridas
authors.affiliation: Consultant Epidemiologist, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada.
authors.forename: Conrad
authors.initials: C
authors.lastname: Kabali
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Raman Krishna
authors.initials: RK
authors.lastname: Kumar
mesh_terms: D006348:Cardiac Surgical Procedures / Q000191:economics*; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006330:Heart Defects, Congenital / Q000191:economics* / Q000601:surgery*; D006801:Humans; D007194:India; D007223:Infant; D007348:Insurance, Health; D008297:Male; D010290:Parents; D011446:Prospective Studies; D012923:Social Class; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers