Economic assessment of the high-tech and primary health care technologies for coronary heart disease according to personalized accounting of medical care for compulsory health insurance

Abstract

Background. The assessment of medical technologies based on digital information is prompt and accurate, but it is currently not widely used, and analysis methods for this have not been developed, which became the basis for this study.

Aim. To economically evaluate the technologies of reperfusion therapy and dispensary observation in coronary heart disease using electronic data on medical care.

Material and methods. 586 patients with myocardial infarction treated in 2016 in two vascular centers of the Orenburg region were identified according to the registers-accounts of the compulsory health insurance fund. Among them were 349 patients with reperfusion therapy (main group) and 237 without it (control group). In the groups, the cost-effectiveness indicator, the cost of inpatient treatment of myocardial infarction and treatment in the postinfarction period were determined. Also, according to the registers-accounts for 2016, 17 225 patients with angina pectoris were identified. Among them, 13 208 patients, who applied to polyclinics for dispensary purposes during 2016–2017, and 4017 patients who did not apply, were registered — the main and control groups. Between groups, the total cost of outpatient, emergency, emergency hospital care and the cost-effectiveness ratio were compared. When processing the data, linear statistics methods and parametric comparison methods (Student's t-test and z-test) were used.

Results. The cost-effectiveness indicator in the group with reperfusion therapy was 425 879, without it — 643 069 rubles/unit, 1.5 times more in the control group. In the postinfarction period, the cost of treatment in the main group was lower than in the control group, 1223.66±19.04 and 1321.11±21.15 rubles, respectively, for outpatient care (p=0.001), 35 138.9±1299.85 and 51 189.6±4903.15 rubles for inpatient care (p=0.002), 4093.0±58.98 and 5428.6±52.95 rubles for an ambulance (p=0.001). The cost of angina treatment in the main group was 2.1 times less than in the control group, 6541.3±85.58 and 13 671.4±92.12 rubles (p=0.001). The cost-effectiveness indicator in the main group was 6867, in the control group it was 15 293 rubles/unit, 2.2 times more in the control group.

Conclusion. The use of reperfusion therapy and dispensary observation in coronary heart disease is economically feasible.

Keywords

ischemic heart disease / dispensary observation / reperfusion therapy / economic feasibility

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