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Health economics
Research
Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study
  1. Kun Yun Lee1,
  2. Tiong Kiam Ong2,
  3. Ee Vien Low3,
  4. Siow Yen Liow4,
  5. Lawrence Anchah5,
  6. Syuhada Hamzah6,
  7. Houng Bang Liew7,
  8. Rosli Mohd Ali8,
  9. Omar Ismail9,
  10. Wan Azman Wan Ahmad10,
  11. Mas Ayu Said11,
  12. Maznah Dahlui1
  1. 1 Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  2. 2 Department of Cardiology, Sarawak Heart Centre, Sarawak, Malaysia
  3. 3 Pharmaceutical Services Division, Ministry of Health, Petaling Jaya, Malaysia
  4. 4 Department of Pharmacy, Clinical Research Centre, Queen Elizabeth 2 Hospital, Kota Kinabalu, Malaysia
  5. 5 Department of Pharmacy, Sarawak Heart Centre, Sarawak, Malaysia
  6. 6 Administrative Office, Penang General Hospital, Pulau Pinang, Malaysia
  7. 7 Division of Cardiology, Clinical Research Centre, Queen Elizabeth 2 Hospital, Kota Kinabalu, Malaysia
  8. 8 Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
  9. 9 Division of Cardiology, Penang General Hospital, Penang, Malaysia
  10. 10 Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  11. 11 Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Julius Centre University of Malaya, 50603 Kuala Lumpur, Malaysia
  1. Correspondence to Dr Kun Yun Lee; leekunyun{at}gmail.com

Abstract

Objectives Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability.

Design This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates.

Setting Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions.

Participants The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded.

Primary and secondary outcome measures The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost.

Results The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost.

Conclusions Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations.

Registration Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR).

  • Costing approach
  • top-down costing
  • research methods
  • hospitalisationcost
  • cardiac centres
  • low- and middle-income countries

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-014307

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    Footnotes

    • Contributors OI, MD, HBL, TKO, RMA, WAWA, SYL, EVL and KYL conceived the overall study. All authors are involved in the design of the study. WAWA, OI, HBL, TKO and RMA led the implementation of the study at each centre, while KYL, EVL, SYL, LA and SH coordinated the data collection. KYL drafted the manuscript. OTK, MAS and MD revised the manuscript critically for intellectual content. All authors read and approved the final manuscript.

    • Funding This work was supported by the Malaysia Ministry of Higher Education High Impact Research MoE Grant UM.C/625/1/HIR/MoE/ E000010-20001 and Malaysia Ministry of Health MRG grant (MRG-MOH-2014-02).

    • Competing interests None declared.

    • Patient consent Not obtained.

    • Ethics approval This study is approved by the Malaysian Ministry of Health Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.