Analysis of the Cost-effectiveness of Routine Medical Examinations and Follow-up at a Krasnodar Territorial Outpatient Clinic
Study Objective: To assess the cost-effectiveness of preventive measures -routine medical examinations and follow-up - for health group IIIa patients with known cardiovascular disease (CVD) at the ambulatory and outpatient department of the Research Institute of Territorial Clinical Hospital No. 1 (a Krasnodar Government-funded Healthcare Institution) in 2015-2018. Materials and Methods: The study was conducted using data collected in 2015 and 2018 during routine medical examinations of adults registered in the territory covered by the ambulatory and outpatient department of Research Institute of Territorial Clinical Hospital No. 1 (a Krasnodar Government-funded Healthcare Institution), as well as 2015-2018 follow-up data on health group IIIa patients with CVD. Comprehensive analysis was done, including estimation of the number of potentially prevented deaths from cardiocirculatory diseases (CCD) of working-age (WA) and economically active (EA) persons for a ten-year period; estimation of costs of years of life saved, including the direct costs of regular medical examinations, using a cost-effectiveness modification of cost-benefit analysis; and comparison of the total cost of years of life saved for CVD patients with average per capita income. Study Results: Regular medical examinations performed in 2015 prevented a total of 33.25 deaths from CCD in a ten-year period: 2.14 deaths within 10 years among WA persons and 5.90 deaths within 10 years among EA persons (up to age 72). Regular medical examinations performed in 2018 and three-year follow-up (of patients with CVD) prevented a total of 38.36 deaths from CCD in a ten-year period: 3.77 deaths within 10 years among WA persons and 13.21 deaths within 10 years among EA persons. For the period 2015-2018 the number of years of life saved in WA patients increased from 22.74 to 49.05. In EA persons the number of years of life saved increased from 25.04 to 63.80. The gain in years of life saved was observed primarily in women, for whom it increased by 30.72, from 21.83 in 2015 to 52.55 in 2018. The costs of the first step of regular medical examinations per patient increased by 36 rubles and 73 kopecks from 2015 to 2018. Over this period the cost of a year of life saved decreased by 50.65%, which suggests that regular medical examinations are effective. This trend towards reduction in the cost of a year of life saved was observed in both WA and EA persons. The cost of treatment for health group IIIa patients with CVD increased by 81,48% in 2015-2018. Calculation of the total costs of a year of life saved, including the direct cost of regular medical examinations and follow-up of health group III patients with CVD, showed that this parameter decreased by 42.1% (22,253 rubles and 95 kopecks) in 2015-2018. This is explained by the increased number of years of life saved and an increase in the number of health group IIIa patients. This trend towards reduction in the cost of a year of life saved was observed both in WA and EA patients. Reduction in the total cost of a year of life saved for health group IIIa patients with CVD was observed simultaneously with an increase in per capita income by 44.7% (from 31,440 rubles to 45,499 rubles) in 2015-2018. Conclusion: Regular medical examinations in 2015 and 2018 and three-year follow-up had a clear economic effect, namely reduction in the cost of a year of life saved by 50.65% for WA and EA persons and reduction in the total cost of a year of life saved by 42.1% for health group IIIa patients with CVD who were followed up.