Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting

PLoS One. 2015 Jun 25;10(6):e0131348. doi: 10.1371/journal.pone.0131348. eCollection 2015.


Introduction: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiac Surgical Procedures / economics*
  • Child, Preschool
  • Family Characteristics
  • Female
  • Health Care Costs
  • Health Resources
  • Heart Defects, Congenital / economics*
  • Heart Defects, Congenital / surgery*
  • Humans
  • India
  • Infant
  • Insurance, Health
  • Male
  • Parents
  • Prospective Studies
  • Social Class
  • Surveys and Questionnaires
  • Tertiary Care Centers

Grant support

This work was funded by the Indian Council of Medical Research grant No. 5/4/1-23/11-NCD-II (www.icmr.nic.in). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.