Abstract:
Background: Heart failure (HF) is a major contributor to cardiovascular morbidity
and mortality. Adversely impacting health outcomes in Kenya and other developing
countries, data on the direct medical cost of HF hospitalization remain limited.
Methods: This was a prospective study conducted at Moi Teaching and Referral
Hospital. Patients with HF were identified by sequential medical chart abstraction.
Primary causes were extracted from echocardiogram reports and adjudicated by a
cardiologist. Direct medical cost of hospitalization was derived using activity-based
and micro-costing methods, adopting payers’ system perspective. Drivers of overall
cost were explored using linear regression models.
Results: 142 participants were consecutively recruited from September to November
2022. 51.4% were females, and the mean age was 54 (SD 20). The leading primary
causes were cor pulmonale (CP), 28.9%; dilated cardiomyopathy (DCM), 26.1%;
rheumatic heart disease (RHD), 19.7%; hypertensive heart disease (HHD), 16.9%;
ischaemic heart disease (IHD), 6.3%; and pericardial disease (PD), 2.1%. Overall direct
cost of HF hospitalization was KES 11,470.94 (SD 8,289.57) [USD 93.49 (67.56)] per
patient per day, with the mean length of hospital stay of 10.1 (SD 7.1). RHD incurred
the highest costs, KES 15,299.08 (SD 13,196.89) [USD 124.70 (107.56)] per patient per
day; IHD, KES 12,966.47 (SD 6656.49) [USD 105.68 (54.25)]; and DCM, KES 12,268.08
(SD 7,816.12) [USD 99.99 (63.71)]. The cost of medications was the leading driver,
β = 0.56 (0.55 – 0.56), followed by inpatient fees, β = 0.27 (0.27 – 0.28), and laboratory
investigations, β = 0.19 (0.18 – 0.19).
Conclusion: Cor pulmonale, CM, RHD, and HHD were the major causes of HF. The overall
direct medical cost of hospitalization was extremely expensive compared with the
Kenyan average monthly household income per capita. Widespread comprehensive
health insurance coverage is therefore recommended to cushion families against such
catastrophic health expenditures besides public health measures aimed at addressing
primary causes of HF
