{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:26:07Z","timestamp":1754162767307,"version":"3.41.2"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Cost transparency is important to facilitate national health infrastructure planning for pediatric cardiac surgery in low-resourced settings. The aim of this paper is to determine direct medical costs of common pediatric congenital heart procedures performed by an in-house cardiac surgery program in Rwanda. Billing information for patients with isolated congenital heart disease who underwent surgery between October 2022 and April 2024 was collected from the hospital management system. Charges were organized into 10 categories, including procedure cost, theater medications and consumables, intensive care unit and ward expenses, anesthesia fees, hospital charges, room charges, testing, and ancillary services. Linear regression was performed to identify perioperative factors associated with increased costs. Costs were converted from Rwandan Francs to US Dollars using the exchange rate 1 USD = 1,262 RWF on 1 January 2024. 117 patients received 8 types of surgeries. Median costs ranged from USD$1,969.04 for patent ductus arteriosus ligation to USD$18,239.00 for arterial switch operation. Excluding the latter, the cost of surgeries was USD$7,662 or less. Theater medications and consumables were the most expensive category accounting for 44.6% (USD$3,071.28) of total costs. This was followed by the cost of cardiothoracic procedure itself which constituted 15.4% (USD$810.90) of total costs. Prolonged hospital stays and operative times increased costs by USD$172.57 and USD$1,015.35 (p &lt; 0.001), respectively. Complications and lesion complexity did not independently predict increased costs (p &gt; 0.05). Direct medical costs of pediatric congenital heart surgeries in Rwanda are generally lower than the mean USD$7,366 plus travel expenses charged abroad. Costs can be lowered by reducing per unit costs of theater consumables and ensuring timely discharge.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004462","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T17:35:22Z","timestamp":1753896922000},"page":"e0004462","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct medical costs of congenital heart surgery for isolated lesions in Rwanda"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4468-5534","authenticated-orcid":true,"given":"Yayehyirad","family":"Ejigu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3468-7018","authenticated-orcid":true,"given":"Vongai C.","family":"Mlambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2586-0974","authenticated-orcid":true,"given":"Kara L.","family":"Neil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yihan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustin","family":"Sendegeya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2759-0947","authenticated-orcid":true,"given":"Stella M.","family":"Umuhoza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josue","family":"Murengezi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9715-4572","authenticated-orcid":true,"given":"Corneille","family":"Ntihabose","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"issue":"3","key":"pgph.0004462.ref001","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S2352-4642(19)30402-X","article-title":"Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"4","author":"Collaborators GBD 2017 Congenital Heart Disease","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"pgph.0004462.ref002","doi-asserted-by":"crossref","first-page":"26","DOI":"10.21037\/asj-21-34","article-title":"Narrative review in pediatric and congenital heart surgery in sub-Saharan Africa: challenges and opportunities in a new era","volume":"1","author":"V Manuel","year":"2021","journal-title":"AME Surg J"},{"issue":"4","key":"pgph.0004462.ref003","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s00268-015-3333-9","article-title":"Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review","volume":"40","author":"I Citron","year":"2016","journal-title":"World J Surg"},{"issue":"9","key":"pgph.0004462.ref004","first-page":"434","article-title":"Diagnosis, management and outcome of heart disease in Sudanese patients","volume":"84","author":"KMA Sulafa","year":"2007","journal-title":"East Afr Med J"},{"key":"pgph.0004462.ref005","first-page":"61","article-title":"The cost of open heart surgery in Nigeria","volume":"14","author":"B Falase","year":"2013","journal-title":"Pan Afr Med J"},{"issue":"1","key":"pgph.0004462.ref006","article-title":"Medical tourism in Nigeria: Challenges and remedies to health care system development","volume":"13","author":"M Abubakar","year":"2018","journal-title":"International journal of development and management review"},{"key":"pgph.0004462.ref007","doi-asserted-by":"crossref","first-page":"100082","DOI":"10.1016\/j.ijcchd.2021.100082","article-title":"Treating pediatric and congenital heart disease abroad? Imperatives for local health system development","volume":"2","author":"D Vervoort","year":"2021","journal-title":"International Journal of Cardiology Congenital Heart Disease"},{"year":"2024","key":"pgph.0004462.ref008","article-title":"Exchange-Rates.Org. Rwanda Franc (RWF) To US Dollar (USD) Exchange Rate History. Exchange-Rates.Org;"},{"key":"pgph.0004462.ref009","doi-asserted-by":"crossref","unstructured":"Faraoni D, Nasr VG, DiNardo JA. Overall hospital cost estimates in children with congenital heart disease: analysis of the 2012 Kid\u2019s Inpatient Database. Pediatric cardiology. 2016;37:37-43.","DOI":"10.1007\/s00246-015-1235-0"},{"issue":"1","key":"pgph.0004462.ref010","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1177\/2150135118808747","article-title":"Direct Medical Costs of Pediatric Congenital Heart Disease Surgery in a Belgian University Hospital","volume":"10","author":"R Willems","year":"2019","journal-title":"World J Pediatr Congenit Heart Surg"},{"key":"pgph.0004462.ref011","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3389\/fped.2020.00357","article-title":"Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned","volume":"8","author":"I El Rassi","year":"2020","journal-title":"Front Pediatr"},{"issue":"3","key":"pgph.0004462.ref012","first-page":"299","article-title":"Understanding the Costs of Surgery: A Bottom-Up Cost Analysis of Both a Hybrid Operating Room and Conventional Operating Room","volume":"11","author":"S Patel","year":"2022","journal-title":"Int J Health Policy Manag"},{"issue":"3","key":"pgph.0004462.ref013","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1177\/21501351221151057","article-title":"Can the Public-Private Business Model Provide a Sustainable Quality Pediatric Cardiac Surgery Program in Low- and Middle-Income Countries?","volume":"14","author":"S Kim","year":"2023","journal-title":"World J Pediatr Congenit Heart Surg"},{"issue":"7","key":"pgph.0004462.ref014","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/BF02724185","article-title":"Congenital heart disease in India: a status report","volume":"72","author":"A Saxena","year":"2005","journal-title":"Indian J Pediatr"},{"year":"2022","author":"The World Bank","key":"pgph.0004462.ref015"},{"key":"pgph.0004462.ref016","article-title":"Narayana Hrudayalaya heart hospital: cardiac care for the poor","author":"T Khanna","year":"2005","journal-title":"China Case Studies"},{"issue":"1","key":"pgph.0004462.ref017","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/hex.12619","article-title":"Impact and experiences of delayed discharge: A mixed-studies systematic review","volume":"21","author":"A Rojas-Garc\u00eda","year":"2018","journal-title":"Health Expect"},{"issue":"2","key":"pgph.0004462.ref018","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.athoracsur.2020.06.059","article-title":"Cardiac Biomarkers Associated With Hospital Length of Stay After Pediatric Congenital Heart Surgery","volume":"112","author":"MD Green","year":"2021","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"pgph.0004462.ref019","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1177\/2150135120988634","article-title":"Pediatric Cardiac Surgical Patterns of Practice and Outcomes in Japan and Europe","volume":"12","author":"J H\u00f6rer","year":"2021","journal-title":"World J Pediatr Congenit Heart Surg"},{"issue":"4","key":"pgph.0004462.ref020","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/1475-6773.13137","article-title":"Impact of pediatric cardiac surgery regionalization on health care utilization and mortality","volume":"54","author":"R Sakai-Bizmark","year":"2019","journal-title":"Health Serv Res"},{"year":"2024","author":"Fourth Population and Housing Census, Rwanda, 2012: Thematic Report on Population Size, Structure and Distribution. National Institute of Statistics of Rwanda: National Institute of Statistics of Rwanda; 2014","key":"pgph.0004462.ref021"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004462","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T17:35:25Z","timestamp":1753896925000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004462"}},"subtitle":[],"editor":[{"given":"Barnabas Tobi","family":"Alayande","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":21,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0004462","relation":{},"ISSN":["2767-3375"],"issn-type":[{"type":"electronic","value":"2767-3375"}],"subject":[],"published":{"date-parts":[[2025,7,30]]}}}