Identification of direct and indirect costs in pulmonary hypertension in Colombia.

Determinación de los costos directos e indirectos en hipertensión pulmonar en Colombia.

Introduction: pulmonary arterial hypertension is an uncommon condition, whose morbidity and mortality are high. Its diagnosis is highly specialized and very costly. The same holds true for its treatment, follow-up, absences from work, and hospitalizations for its cause. In Colombia, the costs associated with the diagnosis and treatment of this condition, which are essential for Methods: Direct costs: the diagnostic algorithm for pulmonary arterial hypertension of the European Respiratory Society (ERS) was applied to an hypothetic cohort of one hundred patients with pulmonary hypertension. A value was assigned to each procedure in accordance with the national tariff manual. Diagnosis was divided into an initial phase, focusing on ruling out groups I, II, IV of pulmonary hypertension, and a second phase, focusing on hemodynamic diagnosis, exercise capabiltiy, and type. A delphi panel indicated therapy according to the functional class, the follow-up procedures, and their frequency. Indirect costs: these were established by interviewing 35 patients with pulmonary arterial hypertension about lost working days and disabilities. Total costs are equal to the sum of direct and indirect costs. All costs are presented in US dollars (1 US dollar = 1.900 Colombian pesos for the year 2010). Results: Direct costs: during the first phase of diagnosis, an investment of US $23,874.90 was done for 100 patients, which represents an investment of US $238,749 per patient. For the second phase, the investment is close to US $14,854.57, corresponding to $742,7 per patient. In patients with functional classes II and III, the total cost for 100 patients is US $9,128,933.46, both for inpatients and outpatients. In functional class IV patients, the total cost of managing 100 individuals is US $35,128,260.2, which represents an average cost of US $351,282.6 per patient. Costs are increased by 384,6% in class IV patients in comparison with class II-III patients. Indirect costs: 31% of surveyed patients had to take leaves from work during the last year (an average of 58 days), and 28,6% required hospitalization. Taking into account that the minimum legal monthly salary in Colombia is US $279, the average monthly income of surveyed patients was US $804 (daily income of US $26,8). The cost of absences from work of the eleven subjects was US $17,098.4. Since insurance companies in Colombia cover only 70% of income from salaries, it can be said that the subjects will have to invest 30% of their monthly income. Conclusions: the direct costs of diagnosing and treating pulmonary arterial hypertension are very high, even when adequate guidelines are used. These costs increase as the functional class worsens. This reminds us of the importance of early diagnosis, not only for improving survival, but also for potentially reducing costs. The direct cost payed by patients with pulmonary arterial hypertension in Colombia had a very high impact on their monthly income, which could reduce their compliance with treatment.