Costs Associated with Preoperative Evaluation Among Vascular Patients in Tikur Anbessa Specialized Hospital
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Date
2025-07
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Addis Ababa University
Abstract
Background :Preoperative evaluation is essential for safe vascular surgery. However, routine tests can impose financial burden on patients, especially in resource-limited settings. This study aim was to assess preoperative evaluation in vascular patients with its associated direct patient costs and cost drivers in Tikur Anbessa Specialized Hospital (TASH).
Methods :An institutional-based retrospective cross-sectional study was conducted for vascular patients operated from January 2022 to December 2024 at TASH, assessing costs associated with preoperative investigations among vascular patients. Data were collected from patients’ records, and phone calls. National Institute for Health and Care Excellence (NICE) guidelines 2016 served as reference to characterize investigation tests. Costs were determined using TASH service fees and private center rates. Data were analyzed using SPSS version 21.
Results A total of 165 elective vascular surgery patients were recruited. Mean age was 49.6 years,88 males, 77 females. Peripheral artery disease was the most common diagnosis (47.3%). The average hospital stay was 13.7 days. The mean total cost of preoperative investigations per patient was 9,717.40 ETB, average imaging cost: 8,797 ETB, laboratory tests cost was 1,328 ETB. CT scans (82.4%) and echocardiography (61.2%) were the most requested imaging. Notably, 20% of ECGs and 43.5% of echocardiograms were not clinically indicated. The mean cost of unindicated tests was 648.99 ETB per patient, with a maximum of 3,565 ETB. Advancing age, having comorbidity, diagnosis type, procedure type and increasing hospital stay, were significantly associated with higher investigation costs. Over 61.3% of patients reported that the cost of investigations was unaffordable to them.
Conclusion : Preoperative evaluation in vascular surgery at TASH is characterized by excessive use of routine and advanced investigations, some of which lack clinical indication. These practices contribute to substantial patient expenses, primarily through out of pocket payment. There is also gap in providing some necessary investigation tests. A large proportion of imaging tests were done in private centers which imposed financial burden to vascular patients. Developing and implementing evidence based testing guidelines could limit the cost and bridge the gap observed.
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Preoperative evaluation